Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The ABC score for massive transfusion is a straightforward tool used by clinicians to quickly assess the likelihood of a trauma patient requiring a substantial blood transfusion, specifically 10 or more units of packed red blood cells (pRBCs). This assessment relies on evaluating four key clinical indicators:

- Presence of a penetrating mechanism of injury
- Systolic blood pressure (BP) of 90 mmHg or less in the emergency department (ED)
- Heart rate (HR) of 120 beats per minute or more in the ED
- Positive result on a focused assessment with sonography for trauma (FAST)

For each of these indicators, a score of 1 is assigned if the condition is met or is true in the patient's clinical presentation. The individual scores are then summed to determine the total ABC score, which ranges from 0 to 4.

To understand the implications of the ABC score:

- A score below 2 suggests that the patient is less likely to require a massive transfusion. In other words, they are unlikely to need 10 or more units of pRBCs.
- Conversely, a score of 2 or greater indicates a higher likelihood that the patient will require such extensive transfusion efforts.

This scoring system efficiently guides medical professionals in decision-making during the rapid and often critical processes of resuscitation following trauma.

The ABC score for massive transfusion, also known as the Assessment of Blood Consumption (ABC) score, is a clinical calculator used in trauma patients. It is designed to predict the need for massive transfusion in patients with severe injuries. The ABC score is calculated based on four parameters: systolic blood pressure, heart rate, positive focused assessment with sonography for trauma (FAST), and penetrating mechanism of injury. 

The ABC score is particularly useful in emergency settings where rapid decision-making is crucial. It helps clinicians to quickly identify patients who are likely to require massive transfusion, allowing for early initiation of blood product preparation and potentially improving patient outcomes. 

The ABC score is not applicable to patients with non-traumatic injuries or those with minor injuries that do not require transfusion. It is also less accurate in predicting the need for massive transfusion in pediatric patients, as the parameters used in the score are based on adult physiological norms.

ABC score for massive transfusion (ABC score)

The TASH score calculator evaluates the risk of needing a massive transfusion for patients who have suffered a severe injury. To compute this score, it gathers inputs related to the patient's condition, assigns numerical values based on predefined criteria, and calculates a total score, which then determines the probability of requiring a massive transfusion.

The calculator collects the following inputs:

1. Sex (Female = 0, Male = 1)
2. Heart rate (> 120 bpm = 2, <= 120 bpm = 0)
3. Systolic blood pressure in mmHg (< 100 = 4, < 120 = 1, >= 120 = 0)
4. Hemoglobin in g/dL (< 7 = 8, < 9 = 6, < 10 = 4, < 11 = 3, < 12 = 2, >= 12 = 0)
5. Base excess in mmol/L (< -10 = 4, < -6 = 3, < -2 = 1, >= -2 = 0)
6. Presence of free intraabdominal fluid (Yes = 3, No = 0)
7. Clinically unstable pelvic fracture (Yes = 6, No = 0)
8. Open or dislocated femur fracture (Yes = 3, No = 0)

Each input option is translated into a score according to the criteria. The scores from these inputs are summed to determine the total TASH score.

The total score provides an interpretation as follows:

| Total Score | Probability Interpretation                     |
|-------------|------------------------------------------------|
| <= 8        | Probability for massive transfusion is < 5%    |
| 9           | Probability for massive transfusion is 6%      |
| 10          | Probability for massive transfusion is 8%      |
| 11          | Probability for massive transfusion is 11%     |
| 12          | Probability for massive transfusion is 14%     |
| 13          | Probability for massive transfusion is 18%     |
| 14          | Probability for massive transfusion is 23%     |
| 15          | Probability for massive transfusion is 29%     |
| 16          | Probability for massive transfusion is 35%     |
| 17          | Probability for massive transfusion is 43%     |
| 18          | Probability for massive transfusion is 50%     |
| 19          | Probability for massive transfusion is 57%     |
| 20          | Probability for massive transfusion is 65%     |
| 21          | Probability for massive transfusion is 71%     |
| 22          | Probability for massive transfusion is 77%     |
| 23          | Probability for massive transfusion is 82%     |
| >= 24       | Probability for massive transfusion is > 85%   |

This process ultimately yields both a numerical score indicating the severity of injury and an associated likelihood of needing massive transfusion, facilitating informed clinical decision-making.

The TASH Score, or Trauma Associated Severe Hemorrhage Score, is a clinical calculator used in the management of patients who have experienced severe trauma. This scoring system is specifically designed to predict the need for massive transfusion in these patients. 

The TASH Score takes into account several factors including patient's age, sex, blood pressure, heart rate, hemoglobin level, base excess, focused assessment with sonography for trauma (FAST), and injuries to the pelvis or femur. Each of these factors is assigned a certain number of points, and the total score is used to predict the likelihood of needing a massive transfusion.

The clinical utility of the TASH Score is to assist clinicians in making quick, evidence-based decisions about the need for massive transfusion in severely injured patients. This can help to optimize resource allocation and potentially improve patient outcomes.

The TASH Score should not be used in patients with minor injuries, as it is specifically designed for use in severe trauma. Additionally, it may not be appropriate for use in patients with certain pre-existing conditions that could affect the variables included in the score, such as chronic anemia or coagulation disorders.

TASH score for massive transfusion after severe injury

Red blood cell transfusion

Use of irradiated blood components

Use of irradiated blood components (intrauterine transfusion and neonatal exchange transfusion)

Transfusion thresholds

Transfusion thresholds, non-bleeding

Coagulation and viscoelastic testing

Correction of preoperative anemia

Correction of preoperative anemia, assessment and timing of surgery

Use of irradiated blood components (technical considerations)

Pre-transfusion assessment

Correction of preoperative anemia, iron supplements and EPO-stimulating agents

Use of irradiated blood components (immunodeficiencies)

Blood sampling and conservation

Patient identification methods

Transfusion thresholds, non-massive bleeding

Use of irradiated blood components (hematologic disorders)

Use of irradiated blood components (solid organ transplantation)

Transfusion thresholds (massive bleeding)

Transfusion thresholds (pediatric patients)

Patients with acute transfusion reactions

Patients with acute transfusion reactions (management of IgA deficiency)

Correction of preoperative anemia, RBC transfusion

Correction of preoperative anemia (thresholds)

Transfusion strategies

Transfusion strategies, massive bleeding

Use of predeposit autologous blood

Use of irradiated blood components (HSCT)

Hospital requirements

Clinical monitoring

Patients with acute transfusion reactions (discontinuation of transfusion)

Pre-transfusion blood sampling

Technical considerations for administration

Preterm infants

Use of irradiated blood components (emergency settings)

Transfusion thresholds (neonatal patients)

Patients with acute transfusion reactions (pharmacotherapy)

Patients with acute transfusion reactions (secondary prevention)

Patients with acute transfusion reactions, evaluation

Prophylactic iron and erythropoietin therapy

Prophylactic iron and EPO therapy

Transfusion strategies (general principles)

Transfusion strategies, non-bleeding

As per ACC/ACEP/AHA/…/SCAI 2025 guidelines, 

Red blood cell transfusion

Guidelines

Key sources