Observational studies have suggested that higher ratios of plasma and platelets to red blood cells (RBCs) might lead to better outcomes for severely bleeding patients requiring massive transfusions. Researchers recently performed a systematic review of the literature in order to determine if a 1:1:1 ratio of plasma, platelets and RBCs decreased morbidity and mortality compared to the standard care or a 1:1:2 ratio. Six randomized controlled trials were identified, and data from two trials with similar transfusion ratios and outcomes were included in a meta-analysis. The authors concluded that the evidence is of low quality, but suggest that there is no difference in 28-day mortality for severely bleeding adult trauma patients that underwent massive transfusions with either a 1:1:1: or 1:1:2 ratio. Additional randomized controlled trials are needed to determine if there may be subtle benefits of higher ratios of plasma and platelets to adult trauma patients or other patient subgroups requiring massive transfusions.
McQuilten ZK, Crighton G, Brunskill S, Morison JK, Richter TH, Waters N, Murphy MF, and EM Wood. Optimal Dose, timing and ratio of blood products in massive transfusion: Results from a systematic review. Transfusion Medicine Reviews. [e-pub. 2017].
