Editing Blood transfusion (section)

=== Significant blood loss ===
A ''massive transfusion protocol'' is used when significant blood loss is present such as in [[major trauma]], when more than ten units of blood are needed. Packed red blood cells, fresh frozen plasma, and platelets are generally administered.<ref name=EMB11>{{cite journal | vauthors = Cherkas D | title = Traumatic hemorrhagic shock: advances in fluid management | journal = Emergency Medicine Practice | volume = 13 | issue = 11 | pages = 1–19; quiz 19–20 | date = November 2011 | pmid = 22164397 | url = http://www.ebmedicine.net/store.php?paction=showProduct&catid=8&pid=244 | url-status = dead | archive-url = https://web.archive.org/web/20120118152838/http://www.ebmedicine.net/store.php?paction=showProduct&catid=8&pid=244 | archive-date = 2012-01-18 }}</ref> Typical ratios of [[fresh frozen plasma]], [[platelets]] and [[packed red blood cells]] are between 1:1:1 and 1:1:2.<ref name="j842">{{cite journal | last1=Meneses | first1=Evander | last2=Boneva | first2=Dessy | last3=McKenney | first3=Mark | last4=Elkbuli | first4=Adel | title=Massive transfusion protocol in adult trauma population | journal=The American Journal of Emergency Medicine | volume=38 | issue=12 | date=2020 | issn=1532-8171 | pmid=33071074 | doi=10.1016/j.ajem.2020.07.041 | pages=2661–6}}</ref>

In some locations, blood has begun to be administered ''pre-hospital'' in an effort to reduce preventable deaths from significant blood loss. Earlier analyses suggested that in the US, up to 31,000 patients per year bleed to death that otherwise could have survived if pre-hospital transfusions were widely available.<ref>{{cite news |last1=Caruba |first1=Lauren |title=Bleeding Out: A new series exploring America's urgent health crisis |url=https://www.dallasnews.com/news/investigations/2023/11/27/bleeding-out-a-new-series-exploring-americas-urgent-health-crisis/#:~:text=For%20more%20than%20two%20years,shootings%2C%20falls%20and%20other%20accidents. |access-date=2023-12-21 |archive-date=2023-12-21 |archive-url=https://web.archive.org/web/20231221230728/https://www.dallasnews.com/news/investigations/2023/11/27/bleeding-out-a-new-series-exploring-americas-urgent-health-crisis/#:~:text=For%20more%20than%20two%20years,shootings%2C%20falls%20and%20other%20accidents. |url-status=live }}</ref> For example, when a mother experiences severe blood loss during pregnancy,<ref>{{cite news |last1=Villalpando |first1=Nicole |title=Whole blood program saves Cedar Park mom's life |url=https://www.statesman.com/videos/news/healthcare/2023/11/09/whole-blood-program-saves-cedar-park-moms-life/71517999007/ |access-date=2023-12-21 |archive-date=2023-12-21 |archive-url=https://web.archive.org/web/20231221230728/https://www.statesman.com/videos/news/healthcare/2023/11/09/whole-blood-program-saves-cedar-park-moms-life/71517999007/ |url-status=live }}</ref> ambulances are able to arrive with blood stored in portable, FDA listed blood refrigerators, similar to those found in blood banks. Once the infusion is given on scene, the patient and the ambulance have more time to get to a hospital for surgery and additional infusions if needed. This could be critical in rural areas or sprawling cities where patients can be far from a major hospital and the local emergency medical team may need to use blood infusions to keep that patient alive during transport.  Larger studies pointed to improvements in 24-hour mortality with pre-hospital plasma and RBC transfusions, but no difference in 30-day or long-term mortality.<ref name="t572">{{cite journal | last1=Rossaint | first1=Rolf | last2=Afshari | first2=Arash | last3=Bouillon | first3=Bertil | last4=Cerny | first4=Vladimir | last5=Cimpoesu | first5=Diana | last6=Curry | first6=Nicola | last7=Duranteau | first7=Jacques | last8=Filipescu | first8=Daniela | last9=Grottke | first9=Oliver | last10=Grønlykke | first10=Lars | last11=Harrois | first11=Anatole | last12=Hunt | first12=Beverley J. | last13=Kaserer | first13=Alexander | last14=Komadina | first14=Radko | last15=Madsen | first15=Mikkel Herold | last16=Maegele | first16=Marc | last17=Mora | first17=Lidia | last18=Riddez | first18=Louis | last19=Romero | first19=Carolina S. | last20=Samama | first20=Charles-Marc | last21=Vincent | first21=Jean-Louis | last22=Wiberg | first22=Sebastian | last23=Spahn | first23=Donat R. | title=The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition | journal=Critical Care | volume=27 | issue=1 | date=2023-03-01 | pmid=36859355 | pmc=9977110 | doi=10.1186/s13054-023-04327-7 | doi-access=free | page=80}}</ref>