Massive transfusion: concepts, protocols and impact on patient survival

Massive transfusion is considered when there is replacement of a significant volume of blood, approximately 10 units of packed red blood cells in an adult, within a 24-hour period, or the need to administer more than 3 to 4 units of packed red blood cells per hour. Several clinical scores can assist the physician in deciding regarding the implementation of the Massive Transfusion Protocol (MTP); however, the use of these scores does not replace clinical judgment. A well-validated scoring system is the Assessment of Blood Consumption (ABC), a tool frequently used in hemotherapy centers. The assessment of the patient's clinical status, in collaboration with the attending physician and the specialized hemotherapy team, becomes crucial to increase the patient's chances of survival. This study was carried out through a literature review in the Google Scholar, SCIELO and PubMed databases, focusing on massive transfusion. The importance of laboratory tests in healthcare was highlighted, in addition to the risks of incorrect or misleading information provided by patients, which can lead to misdiagnoses. This review study highlights the growing relevance of massive transfusion in hemotherapy centers, emphasizing the need for accurate and well-founded protocols. Evidence indicates that restrictive transfusion strategies can reduce mortality, while the ABC score is an effective tool in patient screening. However, individualization of the transfusion decision remains a fundamental aspect for treatment success.