Massive Transfusion Protocol (MTP) — Summary for PPH

1. Activation Criteria (Examples)

• Estimated blood loss > 1500–2000 mL with ongoing bleeding.
• Transfusion anticipated to exceed 4 units RBC in 1–2 hours.
• Hemodynamic instability despite initial resuscitation.
• Clinical concern for rapid progression to exsanguination (e.g., PAS, uterine rupture).

Actual criteria should follow institutional policy. Include pager/phone numbers for blood bank and MTP activation.

2. Initial Transfusion Package (Customize Locally)

• Typical starting ratio: e.g., 4 units RBC : 4 units FFP : 1 apheresis platelet (or equivalent).
• Consider early cryoprecipitate or fibrinogen concentrate when fibrinogen < 200 mg/dL or clinically indicated.
• Use institution-specific massive transfusion boxes / coolers with standardized labels.

3. Ongoing Monitoring

• Repeat labs (CBC, PT/INR, aPTT, fibrinogen, platelets) every 30–60 min or as guided by clinical status.
• Use point-of-care testing (e.g., ROTEM/TEG) if available to direct targeted therapy.
• Monitor ionized calcium; replace as needed to counter citrate toxicity.
• Maintain normothermia (forced-air warming, warmed fluids). Avoid hypothermia-induced coagulopathy.
• Monitor acid–base status (ABG, lactate); treat acidosis to support coagulation and cardiac function.

4. Communication & Logistics

• Clearly designate an MTP leader responsible for communication with blood bank and team.
• Use standardized checklists and documentation forms.
• Notify OR, ICU, neonatology as appropriate.
• Close-out with deactivation call to blood bank once MTP no longer needed.

5. Post-Event Review

• Debrief immediately post-event with key team members.
• Complete institutional hemorrhage / MTP review form.
• Track quality metrics (time to MTP activation, units transfused, maternal outcomes) for QI.

Attach or link your hospital’s full written MTP policy, including detailed dosing and ordering workflows.