Major haemorrhage / massive transfusion
Paediatric emergency management · Circulation · Emergency
Uncontrolled bleeding with shock. Activate the massive transfusion protocol early. Control the bleeding (pressure, tourniquet, surgery), get two large-bore IV/IO, and send crossmatch, gas, coagulation, fibrinogen and calcium.
Resuscitate with blood
- Give blood, not crystalloid, for haemorrhagic shock — limit crystalloid.
- Transfuse in a balanced ratio (about 1:1:1 red cells : FFP : platelets); warm the products.
- Permissive hypotension only where appropriate — not in head injury.
Common questions
What is the first step in major haemorrhage / massive transfusion?
Uncontrolled bleeding with shock. Activate the massive transfusion protocol early. Control the bleeding (pressure, tourniquet, surgery), get two large-bore IV/IO, and send crossmatch, gas, coagulation, fibrinogen and calcium.
What drug doses are used in major haemorrhage / massive transfusion?
Packed red cells: 10–20 mL/kg (uncrossmatched O-negative if life-threatening). Tranexamic acid: 15 mg/kg IV (max 1 g) then an infusion; give within 3 h of trauma. Calcium gluconate 10%: 0.5 mL/kg for ionised hypocalcaemia from citrate.
About this page
Compiled from standard paediatric references. Verify against a current formulary and your local protocol.
Spotted something wrong? Report an error on this page — corrections from clinicians are welcome and are reviewed before any change is published.
Last reviewed 2026-08-12.