Lack of effect of unrefrigerated young whole blood transfusion on patient outcomes after massive transfusion in a civilian setting

Ho, Kwok M.; Leonard, Anton

doi:10.1111/j.1537-2995.2010.02975.x

Cited by 41 publications

(23 citation statements)

References 24 publications

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“…38,39 In contrast, Ho and Leonard found no difference in 30-day mortality in patients who received whole blood compared with components for massive transfusion, defined as ≥ 10 units; however, only one fourth of these patients were treated for traumatic injuries, patients were older than ours (mean age 52 ± 20 years), and diagnoses included gastrointestinal bleeding, cardiothoracic surgery and other types of surgery. 40 Thus, preexisting comorbidities may have produced a confounding effect on mortality.…”

Section: Discussionmentioning

confidence: 99%

Increased Mortality in Adult Patients With Trauma Transfused With Blood Components Compared With Whole Blood

Jones

Frazier

2014

Journal of Trauma Nursing

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Hemorrhage is a preventable cause of death among trauma patients, and management often includes transfusion, either whole blood or a combination of blood components (packed red blood cells, platelets, fresh frozen plasma). We used the 2009 National Trauma Data Bank to evaluate the relationship between transfusion type and mortality in adult major trauma patients (n = 1745). Logistic regression analysis identified three independent predictors of mortality: Injury Severity Score, emergency transfer time, and type of blood transfusion, whole blood or components. Transfusion of whole blood was associated with reduced mortality; thus, may provide superior survival outcomes in this population.

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Section: Discussionmentioning

confidence: 99%

Increased Mortality in Adult Patients With Trauma Transfused With Blood Components Compared With Whole Blood

Jones

Frazier

2014

Journal of Trauma Nursing

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“…[9] The risk of transmitted infectious diseases can be decreased with quick tests for HIV, and hepatitis B and C.…”

Section: Discussionmentioning

confidence: 99%

Should warm fresh whole blood be first choice in acute massive hemorrhage in emergency conditions?

Kendigelen¹,

Kamalak²,

Abat³

2015

Ulus Travma Acil Cerrahi Derg

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Early management of rapid massive hemorrhage requires early administration of blood products and rapid surgical control of bleeding. Professionals in peripheral hospitals with limited resources often work under conditions similar to those in the military. Described in the present report are 3 cases in which warm fresh whole blood (WFWB) was used in patients with massive bleeding who presented to a peripheral hospital that had no blood products suitable for emergency conditions. Described first is the case of a 16-year-old female patient who underwent emergency cesarean section. The patient had massive bleeding from the uterus due to atony. Her hemoglobin (Hb) dropped to 3.5 g/dL. Six units of WFWB were transfused during surgery. Hemodynamic parameters and complete blood count (CBC) stabilized. She was transferred from the intensive care unit (ICU) to obstetrics on day 2 and was discharged on day 7. Described second is the case of a 35-year-old female patient who also underwent emergency cesarean section, and for whom massive bleeding was due to uterine atony. Hb dropped to 2 g/dL and hematocrit (HCT) to 5.4%. Nine units of WFWB were transfused, after which hemodynamic and laboratory parameters stabilized. The patient was extubated the following day, transferred from the ICU to obstetrics on day 3, and was discharged on day 8. Described third is the case of a 36-year-old male patient with stab injuries and hemorrhagic shock who underwent emergency surgery. The patient had injuries to the right renal artery and kidney. Nine units of WFWB were transfused due to continued hemorrhage during surgery. Following surgical control of bleeding and transfusion, hemodynamic parameters improved. The patient was transferred from the ICU on day 5 and discharged on day 10. WFWB transfusion nearly disappeared from civilian medicine after blood was separated into components, and whole blood is not usually available at blood banks. In massive transfusions, WFWB effectively replaces red blood cells (RBCs), platelets, plasma volume, and coagulation factors, while preventing hypothermia and dilutional coagulopathy. Blood components go through biochemical, biomechanical, and immunological changes during long storage, the duration of which affects both transfusion efficacy and associated risks. In the future, with the use of fast donor tests, fast ABO compatibility tests, platelet-sparing leukocyte filters, and developments in pathogen-decreasing technology, fresh whole blood (FWB) may be the first choice for massive transfusion. Future studies will reveal new procedures.

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“…So, taken together, transfusion of fresh whole blood seems to be a reliable strategy in the military, but not in the civilian setting. There was no reduction of mortality in civilian patients with massive hemorrhage [88].Nevertheless, there is still a controversial discussion whether the imitation of whole blood in its entirety by using a fixed ratio of RBCs, FFP and PCs of 1:1:1 are superior to the hemotherapeutic policies in which blood compartments are replaced on demand by particular blood components. The answer is more than uncertain as the conventional coagulation test systems which monitor a state of not well defined 'clinical coagulopathy' did not fulfill all their expectations at bedside.…”

Section: Plateletsmentioning

confidence: 99%

Massive Bleeding and Massive Transfusion

Meißner¹,

Schlenke

2012

Transfus Med Hemother

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Massive bleeding in trauma patients is a serious challenge for all clinicians, and an interdisciplinary diagnostic and therapeutic approach is warranted within a limited time frame. Massive transfusion usually is defined as the transfusion of more than 10 units of packed red blood cells (RBCs) within 24 h or a corresponding blood loss of more than 1- to 1.5-fold of the body’s entire blood volume. Especially male trauma patients experience this life-threatening condition within their productive years of life. An important parameter for clinical outcome is to succeed in stopping the bleeding preferentially within the first 12 h of hospital admission. Additional coagulopathy in the initial phase is induced by trauma itself and aggravated by consumption and dilution of clotting factors. Although different aspects have to be taken into consideration when viewing at bleedings induced by trauma compared to those caused by major surgery, the basic strategy is similar. Here, we will focus on trauma-induced massive hemorrhage. Currently there are no definite, worldwide accepted algorithms for blood transfusion and strategies for optimal coagulation management. There is increasing evidence that a higher ratio of plasma and RBCs (e.g. 1:1) endorsed by platelet transfusion might result in a superior survival of patients at risk for trauma-induced coagulopathy. Several strategies have been evolved in the military environment, although not all strategies should be transferred unproven to civilian practice, e.g. the transfusion of whole blood. Several agents have been proposed to support the restoration of coagulation. Some have been used for years without any doubt on their benefit-to-risk profile, whereas great enthusiasm of other products has been discouraged by inefficacy in terms of blood transfusion requirements and mortality or significant severe side effects. This review surveys current literature on fluid resuscitation, blood transfusion, and hemostatic agents currently used during massive hemorrhage in order to optimize patients’ blood and coagulation management in emergency medical aid.

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Lack of effect of unrefrigerated young whole blood transfusion on patient outcomes after massive transfusion in a civilian setting

Abstract: Unrefrigerated young whole blood transfusion was not associated with a reduced mortality of patients requiring massive transfusion in a civilian setting when other blood products were readily available.

Cited by 41 publications

References 24 publications

Increased Mortality in Adult Patients With Trauma Transfused With Blood Components Compared With Whole Blood

Increased Mortality in Adult Patients With Trauma Transfused With Blood Components Compared With Whole Blood

Should warm fresh whole blood be first choice in acute massive hemorrhage in emergency conditions?

Massive Bleeding and Massive Transfusion

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