What’s in a major haemorrhage pack?
A Major Haemorrhage Pack (MHP) is a locally defined bundle of blood components, haemostatic drugs and consumables assembled to allow rapid, balanced resuscitation of life‑threatening bleeding.
National guidance requires every trust to have a Major Haemorrhage Protocol that specifies local pack contents, activation criteria and roles (NICE NG39, NG24). The sections below summarise items commonly included, the rationale for each, typical practical timings/volumes and the immediate actions expected in the emergency department.
Always follow your local MHP and contact the blood bank early.
Key principles
- Start with a fixed‑ratio, balanced component strategy for active massive haemorrhage and switch to laboratory or point‑of‑care (TEG/ROTEM, fibrinogen)-guided therapy as soon as results allow; many UK MHPs use an initial plasma:RBC ratio of about 1:1 for adults (NICE NG39).
- Give tranexamic acid early in traumatic or major bleeding according to local protocol (earlier administration yields most benefit) (NICE NG39; Resuscitation Council UK).
- Anticipate and correct transfusion‑related physiological problems during massive transfusion, including hypocalcaemia from citrate, hypothermia and acidosis.
- Contact the blood bank immediately when MHP is activated and follow the local Major Haemorrhage Protocol for pack contents, activation steps and responsibilities.
Common components (clinically important items typically in/near an MHP)
- Red blood cells (RBCs) - restore oxygen delivery and intravascular volume; emergency O‑negative stock for immediate use and...