Analyses of blood component transfusion during fixed-ratio-based DCR protocols indicate improved survival with high ratios of plasma and platelet transfusions to RBC transfusions , as first suggested in 2005 (referred to as “balanced transfusion therapy”) and consistent with data subsequently reported by the U.S. Military. The optimal fixed ratio of units of plasma, platelets and RBCs for non-military DCR remains incompletely defined, although likely falls between 1:1:3 and 1:1:1, (plasma:platelets:RBCs). Data from PROMMTT were used to design the recently completed Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR; NCT01545232) trial, which examined a 1:1:1 component transfusion ratio compared to a lower ratio (1:1:2) with survival as the primary endpoint. Of note, the survival benefit from a high plasma:PRBC ratio appears to be similar for any massively transfused patient even if the patient does not have a coagulopathy (for which high plasma:RBC ratios were originally implemented).