Why is calcium used in massive transfusion protocols?

Background: Massive transfusion protocol (MTP) is increasingly used in civilian trauma resuscitation. Calcium is vital for coagulation, but hypocalcemia commonly occurs during massive transfusion due to citrate and serum calcium chelation.

Why does massive transfusion cause hypocalcemia?

The potential for hypocalcemia among patients receiving large amounts of donated blood products over a short time period is due to the presence of the anticoagulant citrate in the bag that donated blood is collected to. Each unit of packed red cells for transfusion contains approximately 3 gm citrate.

How much calcium do you give in a massive transfusion?

However, a massive blood transfusion overwhelms this process. For this reason, calcium needs to be replaced to maintain an ionised calcium level of more than 1.1 mmol/L (NBA 2011).

How does massive blood transfusion prevent hypocalcemia?

Calcium levels can be significantly decreased with rapidly transfused blood products due to the citrate preservative that is added. Citrate binds to the patient’s endogenous calcium when blood products are administered, rendering calcium inactive.

What is the massive transfusion protocol?

“Massive Transfusion Protocol” (MTP) refers to rapid administration of large amounts of blood products (at least 6 units of PRBC) in fixed ratios (usually 1:1:1) for the management of hemorrhagic shock. Only a subset of patients with “massive transfusion” will receive a massive transfusion protocol.

When is it appropriate to activate the massive transfusion protocol?

Massive transfusion protocols are activated by a clinician in response to massive bleeding. Generally this is activated after transfusion of 4-10 units. MTPs have a predefined ratio of RBCs, FFP/cryoprecipitate and platelets units (random donor platelets) in each pack (e.g. 1:1:1 or 2:1:1 ratio) for transfusion.

What is considered a massive blood transfusion?

Massive transfusion, historically defined as the replacement by transfusion of 10 units of red cells in 24 hours, is a response to massive and uncontrolled hemorrhage.

What is considered a massive transfusion?

How much blood is considered a massive transfusion?

What is the most common electrolyte abnormality to develop after a large volume blood transfusion?

Electrolyte abnormalities such as hypocalcemia, hypomagnesemia, and hyperkalemia are common following massive transfusion.

What is the purpose of a massive transfusion protocol?

The goals to the management of massive transfusion include: early recognition of blood loss. maintenance of tissue perfusion & oxygenation by restoration of blood volume & haemoglobin (Hb) arrest of bleeding including with early surgical or radiological intervention, and.