Massive transfusion policy in the Netherlands, a nationwide survey

Background: Massive transfusion protocols (MTPs) guide the physician in optimizing transfusion strategies. Although international guidelines on massive transfusion exist, it is unknown whether all Dutch hospitals adhere to these guidelines. The main objective of this study was to create an overview of the massive transfusion strategies of Dutch hospitals and to evaluate if logistical factors, for example, the unavailability of thawed plasma, influence transfusion practices. Furthermore, this study was initiated to evaluate the interest in a ready-to-use plasma product. Study Design and Methods: A questionnaire on transfusion strategy, available resources, and yearly usage/wastage of transfusion products was distributed to all hospitals in the Netherlands. Results: Sixty-nine hospitals were approached, of which 58 responded (response rate 84%). The majority of hospitals (67%) strived for a 1:1 erythrocyte/plasma ratio. Five percent of the hospitals used an erythrocyte/plasma ratio >2:1, which did not meet (inter)national guidelines. No relation was found between the clinical strategy described in the MTP and available resources; moreover, direct plasma availability did not increase plasma wastage. Hospitals for which it takes longer to have plasma available for transfusion generally are more interested in a ready-to-use plasma product (n = 55, 75.0% vs. 57%). Conclusion: This was the first nationwide survey on massive transfusion practices in the Netherlands. There is clear uniformity when it comes to using an MTP. Logistics surrounding plasma availability or plasma thawing capacity did not influence MTPs. Nevertheless, there seems to be substantial interest in a ready-to-use plasma product, especially in hospitals with limited plasma use.