ABC Score for Massive Transfusion

Why Use

Early initiation of massive transfusion has been shown to improve survival in critical trauma patients. The ABC Score reduces delay in determining need for massive transfusion in a trauma patient, while also providing consistency in appropriateness of transfusion by reducing practice variations among providers.

When to Use

Trauma patients for whom massive transfusion is being considered.

Formula

Pearls / Pitfalls

Does not require laboratory results or complex calculations. The FAST exam used to determine the score relies on the skill level of the person performing and interpreting the study. The score tends to overtriage in favor of receiving massive transfusion, ensuring a low chance of withholding massive transfusion from a patient that needs it. While the score can help aid the decision to initiate massive transfusion, the lead physician(s) managing the trauma should place the order, as a massive transfusion can quickly stretch the limits of the hospital blood supply.

Management

The most widely accepted definition of massive transfusion is the administration of ≥10 units of pRBCs in the first 24 hours. Institutions may have different ratios of blood products as a part of their massive transfusion protocol (MTP). Activation of MTP triggers the release of pRBCs, platelets, and fresh frozen plasma at frequent intervals until it is called off.

Critical Actions

Chances of survival increase with early initiation of massive transfusion in severely injured patients. Identification and activation should not be delayed in critical trauma patients.

Advice

Massive transfusion protocols are institution-specific, but often are 1:1:1 or 1:1:2 for fresh frozen plasma, platelets, and packed red blood cells ( Holcomb 2015 ). Remember, the ABC Score does not indicate if trauma patients should receive blood, only if they should receive blood through a massive transfusion protocol. The score can be repeated as the patient’s clinical exam changes. Repeating vitals and FAST can change a patient’s ABC Score. Familiarity with your institution’s massive transfusion protocol will reduce delays in activation and administration of blood products.

More Information

Interpretation: ABC Score Interpretation 0-1 Not likely to require massive transfusion (≥10 units pRBCs) 2-4 Likely to require massive transfusion