What are the current transfusion protocols for managing massive blood loss in adults?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For adults with massive blood loss, the current transfusion protocol involves using a fixed‑ratio protocol of 1 unit of plasma to 1 unit of red blood cells, and this should be initiated as soon as possible .

Hospital trusts should have specific major haemorrhage protocols for adults, which include early transfusion of blood components guided by laboratory coagulation results, and reassessment of the patient's clinical condition after each transfusion .

In cases of active bleeding, transfusions should be based on clinical assessment and laboratory results, with a focus on maintaining adequate haemostasis and tissue perfusion .

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