Ideally, a massive transfusion protocol (MTP) should be activated only in massively bleeding patients. However, as shown in this and other studies, it is not always possible to predict, at the onset of bleeding, who will bleed massively and who will not. Overactivation of the MTP in non-trauma patients may be have been due to the more elective nature of the procedures for which the MTP was activated (specially surgery) and to the subsequent, rapid control of bleeding, contrary to trauma patients where bleeding is often more difficult to control. Another explanation for the worse outcomes in non-trauma patients may be the overtransfusion of unnecessary blood products.

– Jean-François Hardy