title: Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe.
abstract: BACKGROUND
  The practice of transfusing ones' own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the concern of worsening coagulopathy and the inflammatory process. The aim of this study was to assess outcomes in trauma patients receiving whole blood autotransfusion (AT) from hemothorax.
  
  
  METHODS
  This is a multi-institutional retrospective study of all trauma patients who received autologous whole blood transfusion from hemothorax from two Level I trauma centers. Patients who received AT were matched to patients who did not receive AT (No-AT) using propensity score matching in a 1:1 ratio for admission age, sex, mechanism, type of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, systolic blood pressure, heart rate, hemoglobin, international normalized ratio (INR), prothrombin time, partial prothrombin time, and lactate. AT was defined as transfusion of autologous blood from patient's hemothorax, which was collected from the chest tubes and anticoagulated with citrate phosphorous dextrose. Outcome measures were in-hospital complications, 24-hour INR, and mortality. In-hospital complications were defined as adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation, renal insufficiency, and transfusion-related acute lung injury.
  
  
  RESULTS
  A total of 272 patients (AT, 136; No-AT, 136) were included. There was no difference in admission age (p = 0.6), ISS (p = 0.56), head Abbreviated Injury Scale (AIS) score (p = 0.42), systolic blood pressure (p = 0.88), and INR (p = 0.62) between the two groups. There was no significant difference in in-hospital complications (p = 0.61), mortality (p = 0.51), and 24-hour postadmission INR (0.31) between the AT and No-AT groups. Patients who received AT had significantly lower packed red blood cell (p = 0.01) and platelet requirements (p = 0.01). Cost of transfusions (p = 0.01) was significantly lower in the AT group compared with the No-AT group.
  
  
  CONCLUSIONS
  The autologous transfusion of the patient's shed blood collected through chest tubes for hemothorax was found to be safe without complications in this study. It also reduced the need for allogeneic transfusions and decreased hospital costs. This study demonstrates safety data that would help in designing larger prospective multicenter studies to determine whether this practice is truly safe and effective.
  
  
  METHODS
  Epidemiologic/prognostic study, level III.
authors: From the Division of Trauma, Critical Care, Burns, and Emergency Surgery (B.J., V.P., M.K., G.V., N.K., A.T., A.A., T.O., P.R.), Department of Surgery, University of Arizona, Tucson, Arizona; and Division of Acute Care Surgery and Surgical Critical Care (K.I., S.S.), LAC County+ USC Medical Center, University of Southern California, Los Angeles, California.
authors: Peter
authors: P
authors: Rhee
authors: Kenji
authors: K
authors: Inaba
authors: Viraj
authors: V
authors: Pandit
authors: Mazhar
authors: M
authors: Khalil
authors: Stefano
authors: S
authors: Siboni
authors: Gary
authors: G
authors: Vercruysse
authors: Narong
authors: N
authors: Kulvatunyou
authors: Andrew
authors: A
authors: Tang
authors: Anum
authors: A
authors: Asif
authors: Terence
authors: T
authors: O'Keeffe
authors: Bellal
authors: B
authors: Joseph
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001804:Blood Transfusion, Autologous; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D019934:International Normalized Ratio; D008297:Male; D061214:Patient Safety; D057216:Propensity Score; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
chemical_list: D015415:Biomarkers