Fig 1.

Institution 1 MTP algorithm. The clinical team sends blood samples for initial laboratory tests to the clinical laboratory upon initiation of the MTP. The tests requested include PT, PTT, fibrinogen, D-dimer, and a CBC. If a patient continues to hemorrhage or future hemorrhage is anticipated, additional 6:4:1 packages can be requested from the transfusion service, provided that additional coagulation laboratory kits are sent with each request. Importantly, the massive transfusion guideline does not preclude customized ordering of other blood products and pharmaceuticals. Later in resuscitation, abnormal laboratory values such as prolonged PT and/or PTT, low PLT count, and low fibrinogen values can be addressed individually as depicted. Figure revised with permission from Burtelow et al.⁷