Today we will be discussing the proper transfusion ratio of plasma, platelets and red blood cells for trauma patients. While the rapid transfusion of blood for severely bleeding trauma patients is critical, the exact ratio of plasma to platelets to red blood cells has not been comprehensively examined until now.
Here is Dr. John Holcomb, who spent 23 years in the army treating trauma patients:
“We observed that patients who received early and higher quantities of plasma and platelets in relation to red blood cells appeared to do be better.”
Dr. Holcomb went on to lead the PROPPR randomized clinical trial which examined mortality and exsanguination in 680 severely injured patients at level one trauma centers in North America. In the study, 338 patients received a 1:1:1 ratio of plasma, platelets and red blood cells, while the other 342 patients received a 1:1:2 ratio, or half the amount of plasma and platelets using the red blood cells as a reference.
Dr. Holcomb summarizes the results between the patients receiving a 1:1:1 ratio versus those receiving a 1:1:2 ratio:
“There was no difference in outcome at 24 hours and 30 days. We in a preplanned analysis also looked at the number of patients who exsanguinated or bled to death within 24 hours and in the 1:1:1 group showed a significant decrease in the incidence of hemorrhagic death at 24 hours.”
Higher amounts of plasma and platelets were transfused in the 1:1:1 group. Similar quantities of red blood cells were transfused in both groups, and differences were not detected in any complications. The results from this study show a 1:1:1 ratio of plasma, platelets and red blood cells is best for severely bleeding trauma patients to achieve hemostasis.
Dr. Holcomb adds:
“Early transfusion is associated with improved survival. Our blood banks in 12 centers in North America, both large and small, were able to deliver blood products to the bedside within 8 minutes increasing rapid delivery of 1:1:1 was associated with improved early survival in patients who were bleeding to death.”
We’ll be back with another edition of Transfusion News on March 15. Thanks for joining us.
1. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, del Junco DJ, Brasel KJ, Bulger EM, Callcut RA, Cohen MJ, Cotton BA, Fabian TC, Inaba K, Kerby JD, Muskat P, O’Keeffe T, Rizoli S, Robinson BR, Scalea TM, Schreiber MA, Stein DM, Weinberg JA, Callum JL, Hess JR, Matijevic N, Miller CN, Pittet JF, Hoyt DB, Pearson GD, Leroux B, van Belle G, Group PS. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015;313: 471-82.