What is a massive transfusion protocol?

A massive transfusion protocol (MTP) is a standardized, pre-activated plan for delivering large volumes of blood products rapidly to patients with life-threatening hemorrhage. It coordinates the blood bank, lab, and clinical teams to deliver balanced ratios of packed red blood cells (pRBC), fresh frozen plasma (FFP), and platelets.

What does the 1:1:1 ratio mean?

The 1:1:1 ratio means equal units of pRBC, FFP, and platelets are given together. This balanced approach mimics whole blood and is supported by the PROPPR trial, which showed reduced mortality compared to the traditional 2:1:1 ratio in trauma patients with major hemorrhage.

When should MTP be activated?

MTP is typically activated when a patient is predicted to receive more than 10 units of pRBC in 24 hours, has ongoing hemodynamic instability despite initial resuscitation, shows signs of coagulopathy, or meets trauma scoring criteria such as the ABC score ≥ 2.

Does this calculator replace clinical judgment?

No. This tool is for educational and estimation purposes only. Blood product decisions must be made by qualified clinicians using real-time lab values (TEG/ROTEM, CBC, coagulation studies), patient vitals, and institutional MTP protocols.

What is cryoprecipitate and when is it used?

Cryoprecipitate is a blood product rich in fibrinogen and factor VIII. It is given when fibrinogen falls below 1.5 g/L (150 mg/dL). Some MTP protocols include a fixed cryoprecipitate pack alongside each MTP round; this calculator shows it as an optional add-on.

Massive Transfusion Protocol Ratio Calculator

Name: Massive Transfusion Protocol Ratio Calculator
Availability: InStock
Author: Nham Vu

Enter patient details to calculate pRBC:FFP:platelet ratios for massive transfusion protocol and estimate total units required.

Patient & Protocol Parameters

Patient Weight

MTP Ratio Protocol

1 : 1 : 1

Balanced (PROPPR trial)

2 : 1 : 1

Traditional

Clinical Scenario

Include cryoprecipitate (10-unit pool)

Indicated when fibrinogen < 1.5 g/L; often given with pack 1.

Blood Products per MTP Order

—

pRBC

units

—

FFP

units

—

Platelets

apheresis units

Order Summary

Product	Units	Volume (approx.)
Total	—	— mL

Effective Ratio

—

pRBC

—

FFP

—

Plt

Clinical disclaimer: This calculator is for educational estimation only. All blood product decisions must be guided by real-time laboratory values (CBC, coagulation studies, TEG/ROTEM), patient vitals, and your institution's MTP protocol. Consult your blood bank and attending physician.

Enter patient parameters and click Calculate to see MTP requirements.

Summary

Enter patient details to calculate pRBC:FFP:platelet ratios for massive transfusion protocol and estimate total units required.

How it works

Enter patient weight in kilograms.
Select the MTP ratio protocol (1:1:1 balanced or 2:1:1 traditional).
Choose the clinical scenario to set the target transfusion pack count.
Review the calculated units of pRBC, FFP, and platelets.
Use the summary table to guide blood bank orders.

Use cases

Trauma resuscitation requiring massive transfusion activation.
Major surgical hemorrhage with anticipated large blood loss.
Obstetric hemorrhage with hemodynamic instability.
Emergency department rapid hemorrhage control planning.
Blood bank coordination and pre-ordering for MTP activation.
Teaching and simulation for trauma and critical care teams.

Frequently Asked Questions

Last updated: 2026-07-23 · Reviewed by Nham Vu