Patient Blood Management Guidelines: Module 1

Critical Bleeding Massive Transfusion

| Clinical practice guidance based on evidence or consensus |

4.7 Effect of blood components on outcomes

Question 7 (interventional)

In patients with critical bleeding requiring massive transfusion, what is the effect of FFP, cryoprecipitate, fibrinogen concentrate, and/or platelet transfusion on patient outcomes?

FFP, fresh frozen plasma

Four Level III studies examined the effect of FFP or platelet transfusion on mortality or morbidity.^5,^61,^75,⁹⁵ An RBC:FFP ratio of ≤ 2:1 was reported to be associated with reduced mortality.^61,⁷⁵ However, this outcome is potentially confounded by survivor bias. No studies investigated the use of fibrinogen or cryoprecipitate as an intervention.

Evidence statement

In trauma patients with critical bleeding requiring massive transfusion, an RBC:FFP ratio of ≤ 2:1 is associated with reduced mortality.^61,⁷⁵ (See evidence matrix 10 in Appendix E.)
FFP, fresh frozen plasma; RBC, red blood cell = A = B = C = D (See table 2.2)