Clinical review: Fresh frozen plasma in massive bleedings – more questions than answers.

This well-written review discusses the pros and cons of a formula-driven transfusion protocol whereby RBCs, FFP and platelets are administered in a 1:1:1 ratio. While a formula-driven transfusion protocol may be relevant in the context of military trauma, its benefits in the context of civilian trauma/surgery remain speculative. Use of a formula-driven protocol is particularly inappropriate in non-massively bleeding surgical or trauma patients. It should be remembered that, at present, there are no data from randomized controlled trials to support or to condemn the use of a formula-driven transfusion protocol in any context, whether military or civilian.

– Jean-Franois Hardy