Whole blood for hemostatic resuscitation of major bleeding.
Recent combat experience reignited interest in transfusing whole blood (WB) for patients with life-threatening bleeding. US Army data indicate that WB transfusion is associated with improved or comparable survival compared to resuscitation with blood components. These data complement randomized controlled trials that indicate that platelet (PLT)-containing blood products stored at 4°C have superior hemostatic function, based on reduced bleeding and improved functional measures of hemostasis, compared to PLT-containing blood products at 22°C. WB is rarely available in civilian hospitals and as a result is rarely transfused for patients with hemorrhagic shock. Recent developments suggest that impediments to WB availability can be overcome, specifically the misconceptions that WB must be ABO specific, that WB cannot be leukoreduced and maintain PLTs, and finally that cold storage causes loss of PLT function. Data indicate that the use of low anti-A and anti-B titer group O WB is safe as a universal donor, WB can be leukoreduced with PLT-sparing filters, and WB stored at 4°C retains PLT function during 15 days of storage. The understanding that these perceived barriers are not insurmountable will improve the availability of WB and facilitate its use. In addition, there are logistic and economic advantages of WB-based resuscitation compared to component therapy for hemorrhagic shock. The use of low-titer group O WB stored for up to 15 days at 4°C merits further study to compare its efficacy and safety with current resuscitation approaches for all patients with life-threatening bleeding.
Division of Critical Care, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri.|U.S. Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas.
Philip C
PC
Spinella
U.S. Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas.
Heather F
HF
Pidcoke
Norwegian Naval Special Operations Commando, Bergen, Norway.|Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.
Geir
G
Strandenes
Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.
Tor
T
Hervig
75th Ranger Regiment, Fort Benning, Georgia.
Andrew
A
Fisher
Department of Surgery, College of Medicine, Medical Director, Trauma Center, Mayo Clinic, Rochester, Minnesota.
Donald
D
Jenkins
Department of Pathology, University of Pittsburgh and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
Mark
M
Yazer
Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
James
J
Stubbs
Department of Surgery, University of Pittsburgh, and Division of Trauma, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Alan
A
Murdock
French Military Blood Transfusion Center, Clamart, France.
Anne
A
Sailliol
Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Paul M
PM
Ness
U.S. Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas.
Andrew P
AP
Cap
D001793:Blood Preservation / Q000379:methods; D006470:Hemorrhage / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000628:therapy