• R P Dutton, Martin A Schreiber, Philbert Y Van, Trauma Outcomes Group, G Vercruysse, J MacLeod, P Muskat, J Johannigamn, H M Cryer, P Knudson, M A De Moya, B Tieu, S Brundage, M Brunsvold, K C Sihler, M S Zenait, L Alarcon, R M Stewart, J E Mickalek, T C Nunez, G J Pomper, Susan E Rowell, Ronald R Barbosa, Carrie E Allison, and P Pomper.
• Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA. rowells@ohsu.edu.
• J Trauma. 2011 Aug 1;71(2 Suppl 3):S375-9.

BackgroundRecent data suggest that patients undergoing massive transfusion have lower mortality rates when ratios of plasma and platelets to red blood cells (RBCs) of ≥ 1:2 are used. This has not been examined independently in women and men. A gender dichotomy in outcome after severe injury is known to exist. This study examined gender-related differences in mortality after high product ratio massive transfusion.MethodsA retrospective study was conducted using a database containing massively transfused trauma patients from 23 Level I trauma centers. Baseline demographic, physiologic, and biochemical data were obtained. Univariate and logistic regression analyses were performed. Adjusted mortality in patients receiving high (≥ 1:2) or low (<1:2) ratios of plasma or platelets to RBCs was compared in women and men independently.ResultsSeven hundred four patients were analyzed. In males, mortality was lower for patients receiving a high plasma:RBC ratio at 24 hours (20.6% vs. 33.0% for low ratio, p = 0.005) and at 30 days (34.9% vs. 42.8%, p = 0.032). Males receiving a high platelet:RBC ratio also had lower 24-hour mortality (17.6% vs. 31.5%, p = 0.004) and 30-day mortality (32.1% vs. 42.2%, p = 0.045). Females receiving high ratios of plasma or platelets to RBCs had no improvement in 24-hour mortality (p = 0.119 and 0.329, respectively) or 30-day mortality (p = 0.199 and 0.911, respectively). Use of high product ratio transfusions did not affect 24-hour RBC requirements in males or females.ConclusionUse of high plasma:RBC or platelet:RBC ratios in massive transfusion may benefit men more than women. This may be due to gender-related differences in coagulability. Further study is needed to determine whether separate protocols for women and men should be established.

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