Hospital‐wide massive transfusion over time: Indications, treatment strategies, and clinical outcomes

Abstract Background and Objectives Massive transfusion (MT) is a lifesaving intervention for severe hemorrhage. Contemporary data on indications, transfusion practices, and outcomes across a broad in‐hospital population remain limited. Materials and Methods This retrospective cohort study included adult patients receiving MT at Karolinska University Hospital between 2016 and 2021. MT was defined as transfusion of ≥10 red blood cell (RBC) units within 24 h. Data were obtained from the hospital transfusion registry and medical records. Results A total of 486 MT events were identified. Median age was 60 years (interquartile range [IQR] 46–70), and 65.6% of patients were male. The most common indications were trauma (15.6%), abdominal cancer surgery (15.0%), cardiothoracic surgery (14.0%), and vascular surgery (12.3%). The overall median RBC:plasma:platelet ratio was 5:5:1, consistent with balanced transfusion strategies. MT was more frequently associated with acute than elective procedures (67.2% vs. 32.8%, p < 0.001). Fibrinogen, tranexamic acid, and prothrombin complex concentrate were administered in 69.5%, 52.1%, and 13.6% of cases, respectively. Mortality was 10.3% at 24 h and 31.7% at 30 days. The annual number of MT events decreased significantly during the study period ( p < 0.001), corresponding to an approximately 40% reduction between 2016 and 2021. Conclusion MT was required across a wide range of surgical and medical specialties and remained associated with substantial mortality. Balanced transfusion strategies were well implemented, whereas the use of adjunct hemostatic therapies varied considerably. The marked reduction in MT events over time suggests improvements in hemorrhage management and bleeding control.