In the case of massive acute blood loss, the patient loses all components simultaneously, and coagulopathy may be the first symptom. Typically, a 1:1:1 ratio of blood components is used for massive transfusion. This transfusion results in a dilute mixture of blood components with a hematocrit of 29%, and clotting factors are diluted by about 62% compared to whole blood. In massive component therapy, anticoagulants and preservation solutions, which the patient does not need, are also transfused, further exacerbating coagulopathy and acidosis.

Whole blood doses have a hematocrit of 35-38%, and clotting factors are about 85% compared to pre-donation levels. Whole blood doses contain significantly less anticoagulant and preservation solution.

In the case of acute bleeding, the best option for rapid hemostasis would be donor whole blood, which contains all necessary components in the correct ratio.

Comparative studies between whole blood and component therapy in both military medicine and civilian trauma patients show that whole blood transfusion can increase the survival rate 20-fold if the transfusion occurs within 30 minutes of trauma onset.

In the United States, certified whole blood has a shelf life of up to 35 days at +4°C.