Exsanguination from trauma, gastrointestinal bleeding,and obstetric hemorrhage remains a major source of mortality across the planet. Continued research into resuscitation strategies and evolving technology and blood product storage has allowed for patient to undergo very large volume transfusions, even to the point of replacing a patient’s blood volume several times over. As massive transfusions have become more common, more studies have been performed delineating the exact patient population that would benefit, start-and stop-points of transfusions, complications and avoidance of the same. We discuss these points and provide information and strategies for massive transfusion. Exsanguination from trauma, gastrointestinal bleeding, and obstetric hemorrhage remains a major source of mortality across the planet. Continued research into resuscitation strategies and evolving technology and blood product storage has for patient to undergo very very volume transfusions, even to the point of replacing a patient’s blood volume several times over. As massive transfusions have become more common, more studies have been performed delineating the exact patient population that would benefit, start-and stop-points of transfusions, complications and avoidance of the same. We discuss these points and provide information and strategies for massive transfusion