Reconsideration of massive transfusion and relative questions        HU Bo, LI Jian-guo. Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan 430074, China
Corresponding author：LI Jian-guo，E-mail: drljg181@yahoo.com.cn
Abstract    Massive transfusion (MT) is still used for the treatment of hemorrhage shock before definitive control of life-threatening hemorrhage. The goal of MT in past years was to quickly supply isotonic crystalloids and plasma-poor RBC concentrates to maintain normovolemia and tissue oxygen supply. However, it frequently led to dilutional coagulopathy and “bloody vicious cycle”, which led the mortality rates of hemorrhage shock still at a high level. With the development of modern medicine, MT emphasizes the “hemostatic resuscitation” with increased use of plasma and platelet, and advocate a 1:1:1 ratio of packed RBCs to fresh frozen plasma to platelet transfusions. At the same time, reduction in the use of isotonic crystalloid transfusion and “hypotensive” resuscitation are used before hemorrhage is controlled. Once definitive control of hemorrhage has been established, a restrictive approach to blood transfusion should be implemented to minimize the adverse of blood transfusion.