Limited Resuscitation With Fresh or Stored Whole Blood Corrects Cardiovascular and Metabolic Function in a Rat Model of Polytrauma and Hemorrhage

Abstract

Hemostatic and platelet function of rat whole blood stored at 4°C is preserved for at least 7 days in vitro. Low volume resuscitation with SWB or FWB, but not LR, restores hemodynamic and metabolic function, but not the coagulopathy after severe trauma and hemorrhage.

Platelets derived from fresh and cold‐stored whole blood participate in clot formation in rats with acute traumatic coagulopathy

“…Recent studies demonstrate that human whole blood stored at 4°C preserves fibrinogen level and platelet response to ADP, thrombin, collagen and arachidonic acid for up to 2 weeks (Pidcoke et al , ; Strandenes et al , ). The results from ex vivo studies in rat blood showed that 7‐day refrigerated storage of whole blood modestly reduced the platelet aggregation, had no effect on maximum clot firmness, and shortened the clotting time (Chen et al , ). In this study, the GFP + ‐platelet counts were approximately 15% and 5% of total platelet populations from FWB and SWB transfusion, respectively, and remained relatively stable within 10 min after transfusion.…”

“…We used a well‐developed model that has been previously described (Darlington et al , ; Wu et al , ; Chen et al , ). Briefly, rats (350–400 g) were anesthetized with 1–2% isoflurane/100% oxygen through a nose cone and allowed to breathe spontaneously.…”

“…Recent studies also have shown that transfusion with group O, low anti‐A and anti‐B titre cold‐stored whole blood as a “universal” product is safe in trauma resuscitation (Yazer et al , ; Seheult et al , ). We have recently shown in a rat model of ATC (Darlington et al , ) that resuscitation with either FWB or whole blood stored at 4°C for 7 days (SWB) shows identical correction in haemodynamic and metabolic function, and equivalent impact on platelet function measured by aggregometry (Chen et al , ). This suggests that whole blood, fresh or stored, could be considered as a primary resuscitation fluid for trauma and haemorrhagic shock.…”

The value of cold storage whole blood platelets in trauma resuscitation is like real estate: a function of ‘location, location, location’

“…Using their recently developed and successful trauma rat model, Wu et al () have convincingly demonstrated that SWB platelets actively participate in clot formation at the injured endothelium of the transfused trauma animal. This finding is significant because previous clinical studies have demonstrated clinical benefit from higher ratios of platelet to packed red blood cells (PRBC) transfusion and because, as Wu et al () noted, smaller clinical and animal studies have shown that SWB is safe and possesses the same haemostatic functionality as FWB (Holcomb et al , ; Darlington et al , ; Yazer et al , ; Chen et al , ; Seheult et al , ). Of added interest is the paper's confirmation of the presence of an endogenous platelet dysfunction of trauma that does not translate into an inability to incorporate at the clot site or in an increased clinical susceptibility to multiple organ failure.…”

What's New in Shock, February 2017?

“…Next, Chen et al (11) use a rat model of polytrauma and hemorrhage to demonstrate the utility of whole blood in restoring metabolic and hemostatic function after severe injury. Similarly to human blood stored at 4°C, rat blood kept for 10 days exhibits a prolongation in prothrombin time (PT) and partial thromboplastin time (aPTT) and fall in fibrinogen concentration.…”