Review of a paediatric massive transfusion protocol in a children hospital

Abstract

Aims: Paediatric massive transfusion protocol (MTP) in our institution was introduced in 2013. It is divided into 4 codes based on patient’s weight, which upon activation, facilitate the timely provision of red cells, platelets and plasma in a predetermined ratio. We aimed to review the response time, blood product usage and wastage from MTP activations in our institution. Methods: Transfusion records of paediatric requiring MTP activations from 2013 to 2015 in our institution were reviewed retrospectively. Results: There were a total of 12 MTP activations since 2013. Median response time was 10 minutes (range 6 to >1 hr). MTP was ceased in cycle 1 for 8% of the patients, cycle 2 for 42%, cycle 3 for 33% and beyond cycle 3 for 8%. There were 8% of patients who did not fully utilise the blood products within cycle 1. 2 units of red cells, 1 unit of platelet and 1 unit of plasma were wasted in the 12 MTP activations. Discussion: Paediatric MTP allows the provision of suitable blood products to bleeding patients. There is a need to fine-tune the activation protocol to reduce response time and blood wastage. Blood products within the MTP may be modified to include cryoprecipitate, to better support bleeding emergencies.