Dept of Pathology and Laboratory Medicine, Grant Medical Center, Columbus, OH 43215, USA.
Am J Clin Pathol. 2011 Sep;136(3):364-70. doi: 10.1309/AJCPH16YXJEFSHEO.
A massive transfusion protocol (MTP) in which most non-RBC transfusions were laboratory result-driven was updated to a 1:1:1 RBC/plasma/platelet formula-driven protocol. Platelet count, fibrinogen level, and prothrombin time (PT) were monitored. In the patients who survived the first 12 hours, the results of coagulation tests were analyzed. Irrespective of the MTP or transfused RBC/plasma ratio, a majority of patients became coagulopathic, usually within the first 2 hours, and a fibrinogen deficiency (fibrinogen level, <100 mg/dL [2.9 μmol/L]) was almost always the initial abnormality. The laboratory value trends under each MTP were indistinguishable: PTs were prolonged and platelet counts and fibrinogen levels fell during the first 100 minutes and then corrected back toward baseline. More than 80% of patients in each group were noncoagulopathic at 12 hours. A 1:1:1 formula-driven MTP did not affect the frequency, nature, or duration of coagulopathy according to laboratory test results.
一项以实验室结果为导向的大量输血方案（MTP）更新为 1:1:1 的红细胞/血浆/血小板公式导向方案，其中大多数非红细胞输血都以此为导向。监测血小板计数、纤维蛋白原水平和凝血酶原时间（PT）。在存活 12 小时的患者中，分析凝血试验结果。无论采用 MTP 还是输注的 RBC/血浆比值，大多数患者都出现凝血障碍，通常在最初的 2 小时内发生，并且通常首先出现纤维蛋白原缺乏（纤维蛋白原水平，<100mg/dL[2.9μmol/L]）。在每种 MTP 下，实验室值趋势都没有区别：PT 在最初的 100 分钟内延长，血小板计数和纤维蛋白原水平下降，然后恢复到基线。每组中超过 80%的患者在 12 小时时无凝血障碍。根据实验室检测结果，1:1:1 公式导向 MTP 并未影响凝血障碍的频率、性质或持续时间。
