title: Comparison of platelet transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients (CME).
abstract: BACKGROUND
  At major combat hospitals, the military is able to provide blood products to include apheresis platelets (aPLT), but also has extensive experience using fresh whole blood (FWB). In massively transfused trauma patients, we compared outcomes of patients receiving FWB to those receiving aPLT.
  
  
  METHODS
  This study was a retrospective review of casualties at the military hospital in Baghdad, Iraq, between January 2004 and December 2006. Patients requiring massive transfusion (≥10 units in 24 hr) were divided into two groups: those receiving FWB (n = 85) or aPLT (n = 284) during their resuscitation. Admission characteristics, resuscitation, and survival were compared between groups. Multivariate regression analyses were performed comparing survival of patients at 24 hours and at 30 days. Secondary outcomes including adverse events and causes of death were analyzed.
  
  
  RESULTS
  Unadjusted survival between groups receiving aPLT and FWB was similar at 24 hours (84% vs. 81%, respectively; p = 0.52) and at 30 days (60% versus 57%, respectively; p = 0.72). Multivariate regression failed to identify differences in survival between patients receiving PLT transfusions either as FWB or as aPLT at 24 hours or at 30 days.
  
  
  CONCLUSIONS
  Survival for massively transfused trauma patients receiving FWB appears to be similar to patients resuscitated with aPLT. Prospective trials will be necessary before consideration of FWB in the routine management of civilian trauma. However, in austere environments where standard blood products are unavailable, FWB is a feasible alternative.
authors.affiliation: Walter Reed Army Medical Center, Washington, DC 20307, USA. Jeremy.perkins1@us.army.mil
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Perkins
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: Alec C
authors.initials: AC
authors.lastname: Beekley
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Grathwohl
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Rentas
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D004617:Embolism / Q000209:etiology / Q000401:mortality; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D058734:Exsanguination / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D005169:Factor VIII; D005260:Female; D005340:Fibrinogen; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000209:etiology / Q000401:mortality; D054542:Iraq War, 2003-2011; D053208:Kaplan-Meier Estimate; D008297:Male; D008887:Military Medicine / Q000639:trends*; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D017713:Platelet Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D010983:Plateletpheresis; D016016:Proportional Hazards Models; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D065227:Transfusion Reaction; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014857:Warfare; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen