{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T02:21:26Z","timestamp":1792981286510,"version":"4.5.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T00:00:00Z","timestamp":1699315200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION:<\/jats:title>\n                    <jats:p>Massive hemorrhage calls for massive transfusions (MTs) to maintain adequate hemostasis. Massive transfusion protocols (MTPs) are the appropriate treatment strategy for such patients replacing conventional use of crystalloids. These help in standardizing and optimizing the delivery of blood components in a well-balanced ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>AIM AND OBJECTIVES:<\/jats:title>\n                    <jats:p>The aim of the study is to propose an ideal ratio of blood components for MTP after assessing relationship between ratios of blood components transfused and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODOLOGY:<\/jats:title>\n                    <jats:p>MT was defined as receiving &gt;4 packed red blood cell (PRBC) units within 1 h with the anticipation of continued need for blood products. All MT patients above 13 years of age regardless of cause of bleed were included in the study from December 2015 to October 2017 accounting for a total of 61 patients. Subgroup categorization of study population was done, and physician-driven ratios of the blood components were calculated for each case. The ratios were grouped as high (&gt;1), equal (=1), and low (&lt;1) ratios of fresh frozen plasma (FFP):PRBC and platelet: PRBC, and the relationship of these ratios to the clinical outcome in terms of mortality was examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS AND DISCUSSION:<\/jats:title>\n                    <jats:p>Sixty-one patients underwent MT of which the overall hospital mortality rate was 8.1% with 100% mortality among patients with penetrating trauma followed by 25% with gastrointestinal bleed. Emergency admission was an independent risk factor for mortality. Hypotension before the initiation of MT was detrimental for survival. Efficient communication existed between the treating physicians and transfusion. Majority of survivors received equal ratios of FFP: PRBC and platelet: PRBC, and all nonsurvivors received low ratios of FFP: PRBC. Analysis was statistically indicating better survival with 1:1:1 ratio of PRBC: FFP: platelet.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>The need of the hour is to establish an institutional MTP and ensure compliance with the same. A prospective randomized controlled trial needs to be done to overcome the limitations and confounders of the present study and establish a universal protocol.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ajts.ajts_116_18","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T12:28:26Z","timestamp":1734956906000},"page":"182-190","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Determinants of mortality after massive transfusion - A prospective study"],"prefix":"10.4103","volume":"18","author":[{"given":"Divya","family":"Venugopal","sequence":"first","affiliation":[{"name":"Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susheela Jacob","family":"Innah","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aboobacker Mohamed","family":"Rafi","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Bhaskaran","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,11,7]]},"reference":[{"key":"R1-20241224","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.tmrv.2011.04.002","article-title":"Massive transfusion protocols for patients with substantial hemorrhage","volume":"25","author":"Young","year":"2011","journal-title":"Transfus Med Rev"},{"issue":"Suppl 1","key":"R2-20241224","doi-asserted-by":"crossref","first-page":"i71","DOI":"10.1093\/bja\/aet376","article-title":"Update on massive transfusion","volume":"111","author":"Pham","year":"2013","journal-title":"Br J Anaesth"},{"key":"R3-20241224","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.suc.2012.01.008","article-title":"Massive transfusion of blood in the surgical patient","volume":"92","author":"Raymer","year":"2012","journal-title":"Surg Clin North Am"},{"key":"R4-20241224","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1053\/j.seminhematol.2005.11.019","article-title":"Massive transfusion coagulopathy","volume":"43","author":"Levy","year":"2006","journal-title":"Semin Hematol"},{"key":"R5-20241224","first-page":"S91","article-title":"Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol","volume":"60","author":"Malone","year":"2006","journal-title":"J Trauma"},{"key":"R6-20241224","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/bjh.12247","article-title":"Massive transfusion in children and neonates","volume":"161","author":"Diab","year":"2013","journal-title":"Br J Haematol"},{"key":"R7-20241224","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.transci.2012.06.001","article-title":"Massive transfusion: An overview of the main characteristics and potential risks associated with substances used for correction of a coagulopathy","volume":"47","author":"Seghatchian","year":"2012","journal-title":"Transfus Apher Sci"},{"key":"R8-20241224","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/00005373-199502000-00006","article-title":"Epidemiology of trauma deaths: A reassessment","volume":"38","author":"Sauaia","year":"1995","journal-title":"J Trauma"},{"key":"R9-20241224","first-page":"S3","article-title":"Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations","volume":"60","author":"Kauvar","year":"2006","journal-title":"J Trauma"},{"key":"R10-20241224","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/S1072-7515(98)00082-9","article-title":"Lethal injuries and time to death in a level I trauma center","volume":"186","author":"Acosta","year":"1998","journal-title":"J Am Coll Surg"},{"key":"R11-20241224","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/j.1537-2995.2004.03409.x","article-title":"Blood transfusion rates in the care of acute trauma","volume":"44","author":"Como","year":"2004","journal-title":"Transfusion"},{"key":"R12-20241224","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1053\/j.jvca.2013.05.016","article-title":"Obstetric hemorrhage","volume":"27","author":"Friedman","year":"2013","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R13-20241224","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4037\/ajcc2000.9.3.158","article-title":"Hemostatic defects in massive transfusion: Rapid diagnosis and management","volume":"9","author":"Reiss","year":"2000","journal-title":"Am J Crit Care"},{"key":"R14-20241224","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1097\/01.TA.0000069184.82147.06","article-title":"Acute traumatic coagulopathy","volume":"54","author":"Brohi","year":"2003","journal-title":"J Trauma"},{"key":"R15-20241224","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.injury.2010.11.003","article-title":"Early coagulopathy in trauma patients: An on-scene and hospital admission study","volume":"43","author":"Floccard","year":"2012","journal-title":"Injury"},{"key":"R16-20241224","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/PCC.0b013e31822f1727","article-title":"Coagulopathy and shock on admission is associated with mortality for children with traumatic injuries at combat support hospitals","volume":"13","author":"Patregnani","year":"2012","journal-title":"Pediatr Crit Care Med"},{"key":"R17-20241224","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1093\/bja\/aes361","article-title":"Haemostatic monitoring during postpartum haemorrhage and implications for management","volume":"109","author":"Solomon","year":"2012","journal-title":"Br J Anaesth"},{"key":"R18-20241224","first-page":"951","article-title":"Preconditions of hemostasis in trauma: A review. The influence of acidosis, hypocalcemia, anemia, and hypothermia on functional hemostasis in trauma","volume":"65","author":"Lier","year":"2008","journal-title":"J Trauma"},{"key":"R19-20241224","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1097\/00005373-199805000-00017","article-title":"Hypothermic coagulopathy in trauma: Effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity","volume":"44","author":"Watts","year":"1998","journal-title":"J Trauma"},{"key":"R20-20241224","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1097\/SLA.0b013e3180cc2e94","article-title":"Acidosis and coagulopathy: The differential effects on fibrinogen synthesis and breakdown in pigs","volume":"246","author":"Martini","year":"2007","journal-title":"Ann Surg"},{"key":"R21-20241224","first-page":"S36","article-title":"Damage control resuscitation","volume":"62","author":"Holcomb","year":"2007","journal-title":"J Trauma"},{"key":"R22-20241224","first-page":"1177","article-title":"Damage control hematology: The impact of a trauma exsanguinations protocol on survival and blood product utilization","volume":"64","author":"Cotton","year":"2008","journal-title":"J Trauma"},{"key":"R23-20241224","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1007\/s00268-006-0653-9","article-title":"Coagulopathy: Its pathophysiology and treatment in the injured patient","volume":"31","author":"Tieu","year":"2007","journal-title":"World J Surg"},{"key":"R24-20241224","first-page":"805","article-title":"The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital","volume":"63","author":"Borgman","year":"2007","journal-title":"J Trauma"},{"key":"R25-20241224","first-page":"S69","article-title":"Effect of plasma and red blood cell transfusions on survival in patients with combat related traumatic injuries","volume":"64","author":"Spinella","year":"2008","journal-title":"J Trauma"},{"key":"R26-20241224","first-page":"986","article-title":"An FFP: PRBC transfusion ratio >\/=1: 1.5 is associated with a lower risk of mortality after massive transfusion","volume":"65","author":"Sperry","year":"2008","journal-title":"J Trauma"},{"key":"R27-20241224","doi-asserted-by":"crossref","first-page":"469","DOI":"10.3349\/ymj.2011.52.3.469","article-title":"Clinical observation study of massive blood transfusion in a tertiary care hospital in Korea","volume":"52","author":"Yoon","year":"2011","journal-title":"Yonsei Med J"},{"key":"R28-20241224","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1111\/tme.12022","article-title":"Experience with a massive transfusion protocol in the management of massive haemorrhage","volume":"23","author":"Sinha","year":"2013","journal-title":"Transfus Med"},{"key":"R29-20241224","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1177\/000313481207800622","article-title":"Outcomes after massive transfusion in nontrauma patients in the era of damage control resuscitation","volume":"78","author":"Morse","year":"2012","journal-title":"Am Surg"},{"key":"R30-20241224","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/00005373-200208000-00007","article-title":"A brief episode of hypotension increases mortality in critically ill trauma patients","volume":"53","author":"Zenati","year":"2002","journal-title":"J Trauma"},{"key":"R31-20241224","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1537-2995.2012.03670.x","article-title":"Blood ordering from the operating room: Turnaround time as a quality indicator","volume":"53","author":"McClain","year":"2013","journal-title":"Transfusion"},{"key":"R32-20241224","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1001\/jama.2015.12","article-title":"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","volume":"313","author":"Holcomb","year":"2015","journal-title":"JAMA"},{"key":"R33-20241224","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1186\/cc10498","article-title":"Clinical review: Canadian national advisory committee on blood and blood products \u2013Massive transfusion consensus conference 2011: Report of the panel","volume":"15","author":"Dzik","year":"2011","journal-title":"Crit Care"},{"key":"R34-20241224","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/2013.jamasurg.387","article-title":"The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: Comparative effectiveness of a time-varying treatment with competing risks","volume":"148","author":"Holcomb","year":"2013","journal-title":"JAMA Surg"},{"key":"R35-20241224","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1182\/asheducation-2010.1.463","article-title":"Trauma blood management: Avoiding the collateral damage of trauma resuscitation protocols","volume":"2010","author":"Hannon","year":"2010","journal-title":"Hematology Am Soc Hematol Educ Program"},{"key":"R36-20241224","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1001\/archsurg.2010.216","article-title":"Effect of blood products transfusion on the development of postinjury multiple organ failure","volume":"145","author":"Johnson","year":"2010","journal-title":"Arch Surg"},{"key":"R37-20241224","first-page":"S329","article-title":"High ratios of plasma and platelets to packed red blood cells do not affect mortality in nonmassively transfused patients","volume":"71","author":"Sambasivan","year":"2011","journal-title":"J Trauma"},{"key":"R38-20241224","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.jamcollsurg.2010.01.031","article-title":"Impact of plasma transfusion in trauma patients who do not require massive transfusion","volume":"210","author":"Inaba","year":"2010","journal-title":"J Am Coll Surg"},{"key":"R39-20241224","first-page":"527","article-title":"Optimizing outcomes in damage control resuscitation: Identifying blood product ratios associated with improved survival","volume":"65","author":"Gunter","year":"2008","journal-title":"J Trauma"},{"key":"R40-20241224","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1007\/s00595-013-0518-4","article-title":"Efficacy of a high FFP: PRBC transfusion ratio on the survival of severely injured patients: A retrospective study in a single tertiary emergency center in Japan","volume":"44","author":"Kudo","year":"2014","journal-title":"Surg Today"}],"container-title":["Asian Journal of Transfusion Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ajts.AJTS_116_18","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:00:23Z","timestamp":1786647623000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ajts.AJTS_116_18"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,7]]},"references-count":40,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ajts.ajts_116_18","relation":{},"ISSN":["0973-6247","1998-3565"],"issn-type":[{"value":"0973-6247","type":"print"},{"value":"1998-3565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,7]]},"assertion":[{"value":"2018-09-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}