Massive Transfusion Ratio — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaMassive Transfusion RatioFRCA Final

A 30-year-old man (ASA I, 80 kg) sustains a grade IV splenic laceration in a motorcycle accident. In the operating theatre, massive transfusion protocol is activated. According to current evidence, what is the optimal ratio of packed red cells to fresh frozen plasma to platelets?

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Correct answer: D — 1:1:1

The PROPPR trial (2015) demonstrated that a 1:1:1 ratio of packed red cells: FFP: platelets (simulating whole blood) improved haemostasis and reduced death from exsanguination within 24 hours compared to a 1:1:2 ratio. This balanced resuscitation strategy is now the standard of care for massive transfusion in trauma. Many UK major trauma centres use pre-prepared 'shock packs' containing 4 units RBC: 4 units FFP: 1 unit platelets in a 1:1:1 ratio.

Reference: Holcomb JB et al – 2015 – PROPPR trial; NICE – 2023 – NG39 Major trauma; Association of Anaesthetists – 2025 – Blood components