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Transfusing packed red blood cells (PRBCs) is the appropriate management for a patient with massive trauma and splenic rupture who presents with a hemoglobin level of 6.8. In this scenario, the hemoglobin indicates significant anemia and the need for urgent blood volume restoration. The INR, which is within normal limits at 1.2, suggests that the patient's coagulation status is stable, but given the context of massive trauma, there is still a risk for hypovolemic shock due to blood loss.

Rapidly addressing the patient's hemoglobin level through transfusion of PRBCs is crucial to prevent further deterioration and to stabilize hemodynamics. Maintaining adequate oxygen delivery to tissues is essential in trauma patients, particularly in the setting of splenic rupture where active bleeding may occur.

Other management options such as immediate surgery may not be immediately necessary if the patient is not hemodynamically unstable yet. Starting IV fluids alone could be insufficient to correct severe anemia and may not adequately stabilize the patient, especially if significant blood loss has occurred. Monitoring in the ICU without intervention could delay necessary treatment and potentially worsen the patient's condition, especially given the low hemoglobin level which suggests that immediate intervention is warranted to prevent shock and organ failure.