Massive Transfusion Protocol (MTP)

Posted on Nov 1, 2021 in Clinical Documentation | 0 comments

The Summit campus will go live with Massive Transfusion Protocol (MTP) procedures at ~9AM on 11/10/21.  Below is a brief overview of the MTP process versus orders for uncrossmatched emergency release RBC’s and STAT crossmatched RBC’s.  Educational information can also be found at the Massive Blood Transfusion Education Site: https://sutterhealth.sharepoint.com/sites/ABSMCMBTPROTOCOL

When to use an MTP: 

  • Transfusion of greater than 5 units of RBC in 1 hour
  • Loss or anticipated loss of 1 blood volume within 24 hrs or 50% of blood volume in 3 hrs
  • Bleeding rate  ≥ 150 mL/minute

Activate MTP by calling the Blood Bank (x6563), then place MTP order in Epic

When an MTP is ordered:

  • The blood bank staff stops working on all other orders
  • Prepares packages of blood/blood components per chart below, until MTP is deactivated
Package #Blood Components included
14 RBCs, UNXM or XM, Type O or Type compatible1 Plateletpheresis
24 RBCs, UNXM or XM, Type O or Type compatible4 Plasma (Type AB, A, or Type compatible)2 pre-pooled Cryo (or 10 single Cryo)
34 RBCs, UNXM or XM, Type O or Type compatible4 Plasma (Type AB, A, or Type compatible)1 Plateletpheresis
 Continue with Package 2, 3, 2…….

                **UNXM = Uncrossmatched, XM = Crossmatched

  • Benefits of MTP packages:
    • More timely availability of blood/blood products
    • Maintains 1:1 RBC:Plasma ratio for adequate coagulation
  • Do NOT deviate from established MTP packages à may not get desired benefits noted above; causes confusion for Blood Bank staff (non-standard workflow, question if MTP is needed)
  • Must bring patient ID label to Blood Bank to pick up products
  • Call Blood Bank to deactivate MTP when physician determines MTP can be halted, to minimize wastage of thawed plasma/cryo. 

For Urgent non-MTP blood release:  Call Blood Bank

  • If only UNXM PRBCs are needed, do not activate MTP.  Call Blood Bank to request emergency released UNXM PRBCs and place order for Emergency Blood.  PRBC units will be available just as quickly as those ordered as part of an MTP.
  • If XM PRBCs are needed, order STAT T&C.  Depending on the blood bank testing already done (and the antibody screen is negative), units will be available as follows:
Testing doneUnits available
T&S and ABO recheck~ 15 minutes
T&S only~ 20 minutes after ABO recheck sample received in blood bank
No testing~ 1 hour

Placing an Order for MTP in Epic

1.  Access the Blood Navigator.  You may need to look under More.

2. At the top of the Blood Navigator, check Massive Transfusion and click Open Order Sets