What blood product strategy is commonly emphasized in massive transfusion protocols in TNCC?

• A. Balanced transfusion using red blood cells, plasma, and platelets in roughly 1:1:1 ratios, with warming
• B. Transfuse exclusively red blood cells
• C. Transfuse plasma first, then red blood cells
• D. Platelets alone without plasma or red cells

Answer: (A)

Massive transfusion protocols prioritize restoring both blood volume and the coagulation system, not just red cells. In severe hemorrhage, simply replacing red blood cells fixes oxygen delivery but leaves patients vulnerable to coagulopathy from dilution and loss of clotting factors. A balanced approach uses red blood cells, plasma, and platelets in roughly equal parts (about 1:1:1) and includes warming of all products. This strategy helps maintain coagulation factors and platelet function early, reducing the risk of uncontrolled bleeding and improving outcomes. Transfusing only red blood cells, or prioritizing plasma first, or using platelets alone, fails to address the full hemostatic needs during massive hemorrhage.