One third of all blood donations go to cancer patients, who may need red cells or platelets to get through chemotherapy or other treatments. The blood issued to these patients is preventative: to stop bleeding before it happens.
Active bleeding from trauma, surgery, or obstetric complications needs a different approach.
According to the Washington State Department of Health, up to 40% of trauma patient deaths are related to bleeding and could be prevented by speedy administration of blood components.
When a patient loses a significant volume of blood, the hospital may initiate a massive transfusion protocol (MTP). This may happen after a patient has already received several blood products.
In cases of an accident or other trauma, bleeding may not always be obvious — the patient could be experiencing internal bleeding.
Initiation of a MTP should be considered when two or more of the following criteria are met:
Once initiated, a MTP follows a series of steps, including issuing a predetermined set of blood components in a ratio similar to whole blood. This ensures balanced resuscitation to minimize the impact of trauma and improve patient survival.
While saline solution or electrolyte fluids may be used in emergencies to maintain blood pressure and volume, current research shows that a MTP has superior outcomes during extensive bleeding – there is no substitute for donated blood.
(Why is O+ blood often given in an emergency?)
Quick initiation of a MTP makes a lifesaving difference for severely bleeding patients. The hospital follows a policy that designates specific roles for the available staff, such who is in charge of blood orders and who is the single point of communication with the transfusion service.
The Transfusion Service Laboratory (TSL) also follows a standard operating procedure intended to facilitate blood to the patient in the least amount of time with the smallest margin of error.
Bloodworks has on-site TSLs at three Level 3 trauma centers in the Seattle area: EvergreenHealth, Overlake, and Valley medical centers. And Bloodworks is the primary supplier of blood products to Level 1 and Level 2 trauma centers in our region, such as Harborview and Providence Everett; these hospitals regularly see massive bleeding and initiate MTPs.
For example, when EvergreenHealth initiates a MTP, Bloodworks’ on-site TSL issues a pack of blood products: six units of red cells, six units of plasma, one unit of cryoprecipitate (cryo), and one unit of platelets.
“The team has to prepare 14 blood products, emergently,” said Dr. Theresa Nester, Bloodworks Co-Chief Medical Officer.
The team at Bloodworks’ EvergreenHealth TSL can pull together six units of Type O uncrossmatched red cells in around 10 minutes. “Uncrossmatched” means that, while we have determined the unit’s ABO and Rh type, we have not done any additional compatibility testing.
They will have three units of pre-thawed plasma available, while the other three and the pool of cryoprecipitate (cryo) are stored frozen to extend longevity and will need to be thawed. It takes 8 minutes to thaw cryo, while the plasma can take up to 18 minutes. The platelet unit goes out with the first round of plasma.
If the patient doesn’t stabilize after this first set of 14 units, the provider may need to order more blood products.
In an emergency, every second counts. Bloodworks’ Transfusion Service Labs are staffed around the clock. Bloodworks is in frequent contact with hospital staff during the MTP.
Our transfusion medical staff, including Dr. Nester, is on the phone with the provider team to consult on optimal transfusion support while they take measures to stop the bleeding. Our on-site TSL staff stays in contact with the “runner” picking up blood products to get a sense of whether the patient is stabilizing.
To ensure that all patients get the blood they need, Bloodworks often will ship additional units to the impacted hospital to cover the inventory used during an MTP. We recently sent an additional 100 units of O positive blood after a bleeding event due to complications during an organ transplant.
To conserve blood products, a MTP ends after the patient’s vital signs, clinical laboratory values, and overall picture indicate that the bleeding has slowed significantly.
One MTP patient who stands out for Dr. Nester is a new mom who lost five liters of blood after rupturing her uterus during delivery.
“The team did an amazing job getting product to support that. And they (the excellent OB team and transfusion lab staff) saved her.”
And our blood donors ensure that blood is on the shelf when these emergencies arise.
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