# A trauma client requires massive transfusion. Which ratio reflects the contemporary balanced massive transfusion protocol?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391886&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A trauma client requires massive transfusion. Which ratio reflects the contemporary balanced massive transfusion protocol?

## Option

1. Crystalloid only
2. 1:1:1 PRBC : FFP : platelets — balanced ratio reduces dilutional coagulopathy and improves survival **✔ Correct answer**
3. PRBC only
4. 10:1 PRBC : FFP : platelets

**Correct answer: 2**

## Explanation

Correct (2): Balanced 1:1:1 ratio of PRBC : FFP : platelets (PROPPR trial) reduces dilutional coagulopathy, hypothermia, acidosis (lethal triad). Add cryoprecipitate, calcium replacement (citrate chelates Ca), warm fluids/products, tranexamic acid (TXA) within 3 hours of trauma. Avoid excessive crystalloid (worsens coagulopathy). (1,3,4) Outdated/incorrect.

## In-depth explanation

Memory Tip MTP = "1:1:1 + TXA + Calcium + Warm." Lethal triad of trauma = hypothermia + acidosis + coagulopathy. Avoid excess saline.

## Clinical scenario

Scenario 34-year-old trauma client with class IV hemorrhage; massive transfusion protocol activated.

## Key concepts

- **Massive transfusion protocol** — ≥10 units PRBC in 24h or >4 in 1h; activates 1:1:1 ratio products.
- **Lethal triad** — Hypothermia + acidosis + coagulopathy in trauma; addressed by MTP.
- **Tranexamic acid (TXA)** — Antifibrinolytic; reduces mortality if given within 3 hours of trauma.

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