To the Editor: The past decade has seen significant change in the management of major haemorrhage, including earlier and more aggressive use of fresh frozen plasma (FFP). Australian guidelines now advocate high ratios of FFP to packed red blood cells (PRBC) from the outset of resuscitation.1 Preparation of one unit of FFP for every two units of PRBC is recommended. This approach is supported by a recent meta-analysis demonstrating a reduction in organ failure and mortality with high FFP : PRBC ratios.2
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- 1. National Blood Authority Australia. Patient blood management guidelines: module 1. Critical bleeding/massive transfusion. Canberra: National Blood Authority, 2011. http://www.nba.gov.au/guidelines/module1/index.html#/guidelines/module1/cbmt.pdf (accessed Jan 2012).
- 2. Murad MH, Stubbs JR, Gandhi MJ, et al. The effect of plasma transfusion on morbidity and mortality: a systematic review and meta-analysis. Transfusion 2010; 50: 1370-1383.
- 3. Fatovich DM, Phillips M, Langford SA, Jacobs IG. A comparison of metropolitan vs rural major trauma in Western Australia. Resuscitation 2011; 82: 886-890.
- 4. Schöchl H, Nienaber U, Maegele M, et al. Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy. Crit Care 2011; 15: R83.
- 5. Shakur H, Roberts I, Bautista R, et al; CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376: 23-32.
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We acknowledge the assistance of the haematology specialists of the Australian Red Cross and Perth tertiary hospitals, including Dr Nicole Staples.
No relevant disclosures.