Which component is included in maintaining a balanced transfusion mix during a massive transfusion protocol?

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In a massive transfusion, the goal is to replace blood components in a way that preserves coagulation while restoring oxygen delivery. Red blood cells address oxygen transport, but transfusing many RBCs without other components dilutes clotting factors and platelets, risking coagulopathy. Plasma provides the coagulation factors needed for proper clot formation, and platelets support primary hemostasis. Using a balanced 1:1:1 ratio of plasma, platelets, and red cells helps recreate a whole-blood-like mix, supporting both clotting and oxygen delivery and is associated with better outcomes in severe hemorrhage. Delaying plasma after giving RBCs, or using only RBCs, or transfusing whole blood without regard to a balanced component mix, do not maintain that critical balance.