06.b.iv • Massive blood loss protocol

Major haemorrhage in adult trauma

≥ 40% loss of total blood volume

4 litres in 24 hours 2 liters in 3 hours >150ml/min

Major Haemorrage (MH) may manifest as:

• Heart rate > 110
• Systolic BP <90mmHg

Before transfusion

• Check patient ID
• Use wristbands

Trauma Primary
MH pack

• RBC 5 units
• FFP 4 units
• Platelets 1 unit
Aim for RBC:FFP of 1:1

Standard MH
Primary pack

• RBC 5 units
• FFP 4 units
Aim for RBC:FFP of 2:1

Reassess and document

Get senior help

Contact senior member of clinical team. Contact senior ward nurses Contact portering services

Contact Transfusion

Assess ABC

IV access

Check patient identification

2 large cannula

Send blood samples, cross-match, FBC,
coagulation, biochemistry
Consider arterial blood gas measurement

Resuscitate

IV warm fluids – crystalloid or colloid
Give oxygen

Give blood

Blood loss >40% blood volume is immediately life-threatening

Give 4 units via fluid warmer. Aim for Hb>80g/l
Give Group O if immediate need and/or
blood group unknown

Prevent coagulopathy

Anticipate need for platelets and FFP
after 4 units blood replacement
and continuing bleeding

Give Trauma Primary Major Haemorrhage
(MH) Pack

Order Secondary Major Haemorrhage
(MH) Pack

Correct hypothermia

Correct hypocalcaemia
(keep ionised Ca >1.13mmol/L)

Send FBC and coagulation samples after every
3–5 units of blood given

Contact Haematologist

Get help to stop the bleeding

Ask Transfusion to

‘initiate major haemorrhage protocol’

Check if tranexamic acid given, if not give as soon as possible at a dose of:

• 1g intravenously over 10 minutes followed by
• 1g over 8 hours

When laboratory results available
IF GIVE
Falling Hb Red cells
APPT and/or PT ratio >1.5 FFP 15–20ml/kg
Fibrinogen <1.5g/l and obstetrics <2g/l Cryo-
precipitate (2 pools)
Platelet count <50 x 109/l Platelets 1 adult dose order at 100 x 109/l

Secondary MH pack

• RBC 5 units
• FFP 4 units
• Platelets
• Cryoprecipitate

If bleeding continues repeat secondary pack

Contact surgeons, and clinical colleagues from other specialisms as appropriate