{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:24:24Z","timestamp":1788344664018,"version":"build-2803163510"},"reference-count":16,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,10,9]],"date-time":"2015-10-09T00:00:00Z","timestamp":1444348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Information about patient survival after transfusion of multiple blood volumes is limited, and most reports have focused on trauma patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>STUDY DESIGN AND METHODS<\/jats:title><jats:p>Retrospective study of blood use and survival at 11 hospitals in six nations between 2009 and 2013. Ultramassive transfusion (UMT) was defined as transfusion of 20 or more red blood cell (RBC) units over the course of any 2 consecutive calendar days.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 1975 patients received UMT and a representative sample of 1360 patients was studied in detail. Patients were grouped into seven diagnostic categories: solid organ transplantation (n\u2009=\u2009411), cardiac or major vascular surgery (n\u2009=\u2009317), general surgery (n\u2009=\u2009228), trauma (n\u2009=\u2009221), general medicine (n\u2009=\u2009124), obstetrics (n\u2009=\u200923), and other (n\u2009=\u200936). During the 7 days after initiation of UMT, these patients used more than 120,000 blood components. The median (interquartile range) blood use was 35 (26\u201050) RBC units, 30 (20\u201047) plasma units, and 7 (4\u201013) platelet doses. Five\u2010 and 30\u2010day survival significantly declined with increasing RBC use. Overall survivals of patients receiving UMT were 71% (5 day) and 60% (30 day), and in the subset of 165 patients receiving 60 or more RBC units over 2 consecutive days, 5\u2010day survival was 54% ranging from 17% (trauma) to 75% (solid organ transplant). The decline in survival with increasing RBC transfusions was minimal for patients undergoing solid organ transplantation and was most pronounced for trauma and nonsurgical bleeding patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Trauma was not the leading cause of UMT. Increasing RBC requirements were significantly associated with decreasing survival. However, survival was more strongly associated with diagnostic category than total RBCs transfused, with highest survival rates in solid organ transplant surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.13370","type":"journal-article","created":{"date-parts":[[2015,10,9]],"date-time":"2015-10-09T06:52:11Z","timestamp":1444373531000},"page":"558-563","source":"Crossref","is-referenced-by-count":76,"title":["Survival after ultramassive transfusion: a review of 1360 cases"],"prefix":"10.1111","volume":"56","author":[{"given":"Walter Sunny","family":"Dzik","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Ziman","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Division of Transfusion Medicine UCLA Medical Center Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Cohen","sequence":"additional","affiliation":[{"name":"Lab Medicine and Pathology University of Minnesota Medical Center Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menaka","family":"Pai","sequence":"additional","affiliation":[{"name":"Medicine and Department of Pathology and Molecular Medicine McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Lozano","sequence":"additional","affiliation":[{"name":"Hemotherapy and Hemostasis University Clinic Hospital Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Pathology Brigham and Women's Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Delaney","sequence":"additional","affiliation":[{"name":"Laboratory Medicine University of Washington, and Puget Sound Blood Center Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Selleng","sequence":"additional","affiliation":[{"name":"Institut for Immunology and Transfusion Medicine Ernst\u2010Moritz\u2010Arndt\u2010University Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael F.","family":"Murphy","sequence":"additional","affiliation":[{"name":"John Radcliffe Hospital NHS Blood &amp; 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