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ABC Score for Massive Transfusion

Calculators  Hematology
The Assessment of Blood Consumption (ABC) score identifies trauma patients who may need Massive Transfusion (MT).
Penetrating Mechanism
No 0
Yes 1
Systolic Blood Pressure ≤90
No 0
Yes 1
Heart Rate ≥120
No 0
Yes 1


Measured Factor
ABC score
Measured Factor Disease
  • Severe loss of blood
  • Hemorrhage
  • Massive transfusion is needed
Measured Factor Detail
The ABC score identifies trauma patients who may need massive transfusion in order to prevent lethal exsanguination and improve their survival. Massive transfusion is defined as transfusion with ≥10 units of packed red blood cells within 24 hours of injury. The ABC depends on penetrating mechanism, systolic blood pressure, heart rate, Focused Assessment with Sonography for Trauma (FAST). FAST is as a screening test for blood around the heart or abdominal organs after trauma.Penetrating mechanism: No = 0; Yes = 1 | Systolic blood pressure ≤90: No = 0; Yes = 1 | Heart rate ≥120: No = 0; Yes = 1 | Positive FAST: No = 0; Yes = 1
Emergency Medicine Physician
Body System
Measured Factor High Impact
  • A score < 2 indicates that the need to received massive transfusion is unlikely
  • A score ≥2 indicates that the need to received massive transfusion is likely. The score ranges from 0 to 4.

Result Interpretation

Ranges Ranges
  • Critical High: Score ≥2
  • Normal: 0
  • Normal Adult Male: 0
  • Normal Adult Female: 0
  • Normal Geriatric Male: 0
  • Normal Geriatric Female: 0
Result High Conditions
  • Severe loss of blood
  • Hemorrhage
  • Massive transfusion is needed
Test Limitations
Decreased mental status, elevated international normalized ratio (>1.5), decreased hemoglobin (<11.0 g/L), low pH (<7.25), persistent hemodynamic instability, active bleeding requiring operation, or angioembolization also predict massive transfusion needs but are not included in the calculation of ABC score.
References: 2


Study Validation 1
The ABC score was validated at three Level I trauma centers from July 2006 to June 2007.  Sensitivity and specificity for the ABC score ranged from 75% to 90% and 67% to 88%, respectively. Area under receiver-operating characteristic curve, which was used to compare the predictive ability of ABC score, was 0.83 to 0.90. The study concluded that the ABC score was a valid tool to predict the need for massive transfusion.
References: 3
Study Validation 2
Three massive transfusion predictive models, Assessment of Blood Consumption (ABC), Trauma-Associated Severe Hemorrhage (TASH), and McLaughlin scores were validated in 373 major trauma patients, regardless of blood product requirements. Among 38 patients required massive transfusion; 34 were predicted by ABC, 1 by TASH, and 6 by McLaughlin. ABC (area under the receiver operating characteristic [AUROC] = 0.86) was predictive of massive transfusion, whereas TASH (AUROC = 0.51) and McLaughlin (AUROC = 0.56) were not. The ABC score correctly identified 89% of massive transfusion patients at a rural Level I trauma center whereas the TASH and McLaughlin scores were not.
References: 4


Bryan Cotton, MD, is an associate professor in the Department of Surgery and the Center for Translational Injury Research at the University of Texas Health Center at Houston, United States.


  1. Nunez TC, Voskresensky IV, Dossett LA, Shinall R, Dutton WD, Cotton BA. Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? J Trauma. 2009 Feb;66(2):346-52.
  2. Cantle PM, Cotton BA. Prediction of Massive Transfusion in Trauma. Crit Care Clin. 2017 Jan;33(1):71-84.
  3. Cotton BA, Dossett LA, Haut ER, Shafi S, Nunez TC, Au BK, et al. Multicenter validation of a simplified score to predict massive transfusion in trauma. J Trauma. 2010 Jul;69 Suppl 1:S33-9.
  4. Krumrei NJ, Park MS, Cotton BA, Zielinski MD. Comparison of massive blood transfusion predictive models in the rural setting. J Trauma Acute Care Surg. 2012 Jan;72(1):211-5.

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