A massive transfusion protocol (MTP), which includes the dose, timing, and ratio of transfused blood components, is recognized as a useful tool in clinical transfusion medicine. In patients with critical bleeding requiring massive transfusion, the use of a MTP for the timely and appropriate use of red blood cells and other blood components can reduce the risk of mortality. On September 1, 2025, new Rules for the Procurement, Storage, Transportation, and Clinical Use of Donor Blood and Its Components came into effect in Russia. These rules stipulate that «A medical organization carrying out the clinical use of donor blood and/or components approves a massive transfusion protocol, including a list of medical procedures and the procedure for interaction between healthcare professionals involved in providing medical care during massive transfusion» (Article 100). In order to develop a massive transfusion protocol (MTP), a two-stage (79 experts in the first stage and 71 in the second) professional examination of the possible content of the document was carried out using the Delphi method. It was established that differences in the conditions and content of medical care across organizations justify the lack of need for a universal MTP. A MTP model was developed, including seven components: 1) initiation, 2) command, 3) tranexamic acid, 4) testing, 5) blood transfusion, 6) temperature, and 7) termination. A ranking of MTP component activities was determined, and additional measures for creating MTP in medical organizations were proposed.

blood, blood component, blood transfusion, massive transfusion protocol.