title: Measurement of haemolysis markers following transfusion of uncrossmatched, low-titre, group O+ whole blood in civilian trauma patients: initial experience at a level 1 trauma centre.
abstract: OBJECTIVE
  The safety of administering uncrossmatched, group O, cold-stored, whole blood (cWB) during civilian trauma resuscitation was evaluated.
  
  
  METHODS
  Male trauma patients with haemorrhage-induced hypotension who received leuko-reduced uncrossmatched group O+, low titre (<50) anti-A and -B, platelet-replete cWB during initial resuscitation were included. The biochemical markers of haemolysis (lactate dehydrogenase, total bilirubin, haptoglobin, creatinine, serum potassium) were measured on the day of cWB receipt (day 0), and over the next 2 days, reports of transfusion reactions and total blood product administration in first 24 h of admission were recorded.
  
  
  RESULTS
  There were 27 non-group O and 17 group O cWB recipients. The median number of cWB units transfused was 1 [interquartile range (IQR): 1-2] in both groups. The median day 0 post-transfusion serum total bilirubin concentration, although still in the normal range, was higher in the non-group O versus group O recipients (1·4 versus 0·5 mg/dL, P < 0·01). There were no significant differences in any of the other biochemical parameters at any other time point. Non-group O recipients received a median of 3 times more red blood cell (RBC) units compared with group O recipients (P = 0·01 RBCs), likely explaining the bilirubin difference on day 0. The median volume of ABO-incompatible plasma transfused to non-group O recipients was 600 mL (IQR: 300-1140 mL). There were no reports of adverse events related to the cWB transfusion in either group.
  
  
  CONCLUSIONS
  Administration of ≤2 units of cWB in civilian trauma resuscitation was not associated with clinically significant changes in laboratory haemolysis markers. Efficacy will be determined when larger quantities are transfused.
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: J N
authors.identifier: http://orcid.org/0000-0002-6850-7495
authors.initials: JN
authors.lastname: Seheult
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.|The Institute for Transfusion Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Triulzi
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Alarcon
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Sperry
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: A
authors.initials: A
authors.lastname: Murdock
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.|The Institute for Transfusion Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Yazer
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers; D001803:Blood Transfusion; D003404:Creatinine / Q000097:blood; D005260:Female; D006242:Haptoglobins / Q000378:metabolism; D006461:Hemolysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000097:blood* / Q000628:therapy*
chemical_list: D000017:ABO Blood-Group System; D015415:Biomarkers; D006242:Haptoglobins; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001663:Bilirubin; D011188:Potassium
keywords: adverse events; civilian; haemolysis; resuscitation; transfusion; trauma; whole blood