MTP activation - Knowing when to call it
Feb 23, 2026
Critical bleeding can develop quickly and be life-threatening. As perianaesthesia nurses we see that timely activation of a Massive Transfusion Protocol (MTP) or Major Haemorrhage Protocol (MHP) can make the difference between stabilising a patient and irreversible shock. These protocols exist to streamline resuscitation, blood component delivery, and multidisciplinary care during catastrophic haemorrhage.
In the setting of massive haemorrhage, waiting for lab confirmation can cost precious time. Good clinical practice involves recognising physiological signs of ongoing blood loss - persistent hypotension, tachycardia, poor perfusion, metabolic acidosis, and evidence of coagulopathy - and combining these with bleeding history or mechanism to guide activation.
The updated Patient Blood Management Guidelines recommend that institutions have an MTP/MHP as standard of care for critical bleeding and emphasise early assessment and correction of deranged physiology and haemostasis. In trauma settings, several predictive tools like the ABC score or more detailed decision aids exist, but these should support - not replace - clinician assessment and judgement because no single score is perfectly sensitive or specific.
🧠 Key points
- In severe bleeding, activate MTP early when ongoing massive blood loss is anticipated.
• Look for hemodynamic instability + signs of coagulopathy rather than only lab thresholds.
• Use clinical scores (e.g., ABC) as decision aids, not rigid triggers.
• Early tranexamic acid and physiological optimisation improve outcomes.
Calling an MTP is not “routine transfusion”; it is mobilising a coordinated resuscitation to correct physiology and restore oxygen and clotting factors rapidly. Close collaboration with blood bank, surgeons and ICU is essential. Timely activation - that is, recognising the physiology before the crisis deepens - is a hallmark of excellent perianaesthesia care.
References
Mitra, B., Jorgensen, M., Reade, M.C., et al. (2024). Patient blood management guideline for adults with critical bleeding. Med J Aust.
Wangoo, K., Nguyen, V.D.D., Byth, K., et al. (2025). Massive transfusion protocol prediction decision aids in an Australian trauma setting. Blood Coagulation & Fibrinolysis.
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