Which ratio is used in the massive transfusion protocol for hemorrhagic shock?

• A. 1:1:1
• B. 2:1:1
• C. 1:2:1
• D. 1:1:2

Answer: (A)

In massive transfusion for hemorrhagic shock, the aim is to replace red cells, clotting factors, and platelets in a way that supports both oxygen delivery and coagulation. The 1:1:1 ratio—packed red blood cells, fresh frozen plasma, and platelets given in roughly equal parts—best achieves this by mimicking whole blood. Red cells restore oxygen-carrying capacity; plasma supplies essential coagulation factors and helps correct dilutional coagulopathy; platelets provide the necessary cellular components for clot formation. This balanced approach helps prevent ongoing bleeding and has been associated with better survival in trauma patients. Ratios that skew toward red cells or toward plasma/platelets alone can leave the patient under-treated for the other essential components, increasing the risk of coagulopathy or inadequate oxygen delivery. Therefore, the commonly used ratio is 1:1:1.