Adult major haemorrhage protocol

NHS Tayside ED Guidance
NHS Tayside
  1. Call 2222 state massive haemorrhage ward X:
    • Switchboard will voice page site manager, transfusion lab BMS, transfusion practitioner, haematology registrar.
  2. Call blood bank ext 33394 state "massive haemorrhage": give patient name, CHI, location, your name and contact details.
  3. Summon additional clinical support: nominate team lead and communication lead to hand all calls.
  4. Send urgent blood samples: 
    • FBC
    • Coagulation screen
    • Fibrinogen
    • Crossmatch
    • U & E
    • Calcium
  5. Blood bank will issue:
    • 4 units red cells
    • 4 units FFP
    • 1 unit platelets
  6. Resuscitate patient "ABCDE" approach:
    • Use emergency O RhD negative blood if required immediately
    • Trauma less than 3 hours - consider tranexamic acid 1g
    • Aim to control haemorrhage
    • Transfuse red cells/FFP/platelets
    • Use blood warmer
    • Consider cell salvage where available
  7. Ongoing bleeding after initial transfusion?
    • Repeat blood samples
    • Transfuse further RBC and FFP at a ration of 2:1 (1:1 in trauma)
    • Cryoprecipitate if fibrinogen under 1g/L (under 2g/L in obstetric haemorrhage)
    • Consider further platelets
  8. When blood results available maintain:
    • Hb over 80g/L
    • APTT and PT ration under 1.5
    • Platelets over 50 x 109/L
    • Fibrinogen over 1.5g/L (over 2g/L in obstetric haemorrhage)
  9. Bleeding controlled:
    • Communication lead to notify blood bank to "stand down"
    • Complete massive haemorrhage activation record proforma

Contact numbers:

  • Ninewells Transfusion lab 32953
  • PRI transfusion lab 13338 (bleep 5122 out of hours)
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