title: Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital.
abstract: OBJECTIVE
  Fresh whole blood (FWB) and red blood cells (RBCs) are transfused to injured casualties in combat support hospitals. We evaluated the risks of FWB and RBCs transfused to combat-related casualties.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Deployed U.S. Army combat support hospitals.
  
  
  METHODS
  Donors of FWB and recipients of FWB and RBCs.
  
  
  RESULTS
  The storage age of RBCs at transfusion was measured as an indicator of overall risk associated with the storage lesion of RBCs between January 2004 and December 2004 at one combat support hospital. Between April 2004 and December 2004, FWB was prescreened only at one combat support hospital for human immunodeficiency virus, hepatitis C virus, and hepatitis B surface antigen before transfusion. To estimate the general incidence of infectious agent contamination in FWB units, samples collected between May 2003 and February 2006 were tested retrospectively for human immunodeficiency virus, hepatitis B surface antigen, hepatitis C virus, and human lymphotropic virus. Results were compared between FWB samples prescreened and not prescreened for infectious agents before transfusion. At one combat support hospital in 2004, 87 patients were transfused 545 units of FWB and 685 patients were transfused 5,294 units of RBCs with a mean age at transfusion of 33 days (+/- 6 days). Retrospective testing of 2,831 samples from FWB donor units transfused in Iraq and Afghanistan between May 2003 and February 2006 indicated that three of 2,831 (0.11%) were positive for hepatitis C virus recombinant immunoblot assay, two of 2,831 (0.07%) were positive for human lymphotropic virus enzyme immunoassay, and none of 2,831 were positive for both human immunodeficiency virus 1/2 and hepatitis B surface antigen by Western blot and neutralization methods, respectively. The differences in the incidence of hepatitis C virus contamination of FWB donor units between those prescreened for hepatitis C virus (zero of 406; 0%) and not prescreened (three of 2,425; 0.12%) were not significant (p = .48).
  
  
  CONCLUSIONS
  The risk of infectious disease transmission with FWB transfusion can be minimized by rapid screening tests before transfusion. Because of the potential adverse outcomes of transfusing RBCs of increased storage age to combat-related trauma patients, the risks and benefits of FWB transfusions must be balanced with those of transfusing old RBCs in patients with life-threatening traumatic injuries.
authors.affiliation: U.S. Army Institute of Surgical Research, San Antonio, TX, USA. pspinella@ccmckids.org
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Perkins
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Grathwohl
authors.forename: Thomas
authors.initials: T
authors.lastname: Repine
authors.forename: Alec C
authors.initials: AC
authors.lastname: Beekley
authors.forename: James
authors.initials: J
authors.lastname: Sebesta
authors.forename: Donald
authors.initials: D
authors.lastname: Jenkins
authors.forename: Kenneth
authors.initials: K
authors.lastname: Azarow
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D017707:Erythrocyte Transfusion / Q000009:adverse effects; D006772:Hospitals, Military; D006801:Humans; D007493:Iraq; D008889:Military Personnel; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy*