title: Low titer group O whole blood in emergency situations.
abstract: In past and ongoing military conflicts, the use of whole blood (WB) as a resuscitative product to treat trauma-induced shock and coagulopathy has been widely accepted as an alternative when availability of a balanced component-based transfusion strategy is restricted or lacking. In previous military conflicts, ABO group O blood from donors with low titers of anti-A/B blood group antibodies was favored. Now, several policies demand the exclusive use of ABO group-specific WB. In this short review, we argue that the overall risks, dangers, and consequences of "the ABO group-specific approach," in emergencies, make the use of universal group O WB from donors with low titers of anti-A/B safer. Generally, risks with ABO group-specific transfusions are associated with in vivo destruction of the red blood cells transfused. The risk with group O WB is from the plasma transfused to ABO-incompatible patients. In the civilian setting, the risk of clinical hemolytic transfusion reactions (HTRs) due to ABO group-specific red blood cell transfusions is relatively low (approximately 1:80,000), but the consequences are frequently severe. Civilian risk of HTRs due to plasma incompatible transfusions, using titered donors, is approximately 1:120,000 but usually of mild to moderate severity. Emergency settings are often chaotic and resource limited, factors well known to increase the potential for human errors. Using ABO group-specific WB in emergencies may delay treatment because of needed ABO typing, increase the risk of clinical HTRs, and increase the severity of these reactions as well as increase the danger of underresuscitation due to lack of some ABO groups. When the clinical decision has been made to transfuse WB in patients with life-threatening hemorrhagic shock, we recommend the use of group O WB from donors with low anti-A/B titers when logistical constraints preclude the rapid availability of ABO group-specific WB and reliable group matching between donor and recipient is not feasible.
authors.affiliation: *Department of Immunology and Transfusion Medicine, Haukeland University Hospital; and †Norwegian Naval Special Operation Commando, Bergen, Norway; ‡Department of Transfusion Medicine, Örebro University Hospital, Örebro, Sweden; §US Army Institute of Surgical Research, FT Sam Houston, Texas; ∥Institute of Clinical Science, The University of Bergen, Norway; ¶Australian Defense Force Joint Health Command, Canberra, Australian Capital Territory; **French Military Medical Service, Clamart, France; ††Commander French Military Blood Transfusion Center, Clamart, France; ‡‡Director, US Army Blood Program and §§US Army Transfusion Medicine Consultant to the Surgeon General San Antonio Military Medical Center, JBSA-Fort Sam Houston, Texas; ∥∥Transfusion Medicine Division, Johns Hopkins Medical Institutions, Baltimore, Maryland; ¶¶NHS Blood and Transplant, Birmingham, England, United Kingdom; and***Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri.
authors.forename: Geir
authors.initials: G
authors.lastname: Strandenes
authors.forename: Olle
authors.initials: O
authors.lastname: Berséus
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
authors.forename: Tor
authors.initials: T
authors.lastname: Hervig
authors.forename: Michael
authors.initials: M
authors.lastname: Reade
authors.forename: Nicolas
authors.initials: N
authors.lastname: Prat
authors.forename: Anne
authors.initials: A
authors.lastname: Sailliol
authors.forename: Richard
authors.initials: R
authors.lastname: Gonzales
authors.forename: Clayton D
authors.initials: CD
authors.lastname: Simon
authors.forename: Paul
authors.initials: P
authors.lastname: Ness
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Doughty
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.forename: Einar K
authors.initials: EK
authors.lastname: Kristoffersen
mesh_terms: D000017:ABO Blood-Group System; D000906:Antibodies / Q000276:immunology; D001787:Blood Group Incompatibility; D001788:Blood Grouping and Crossmatching; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel; D061214:Patient Safety; D017713:Platelet Transfusion / Q000009:adverse effects*; D012771:Shock, Hemorrhagic / Q000628:therapy; D065227:Transfusion Reaction; D014857:Warfare
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies