Low titer Group O whole blood utilization in pediatric trauma resuscitation: A National Survey

Abstract

Background Renewed interest in low titer group O whole blood (LTOWB) transfusion has led to increased utilization in adult trauma centers; little is known regarding LTOWB use in pediatric centers. Study design and methods A survey of LTOWB utilization at American pediatric level 1 trauma centers. Results Responses were received from 43/72 (60%) centers. These institutions were primarily urban (84%) and pediatric‐specific (58%). There were 16% (7/43) centers using LTOWB, 7% (3/43) imminently initiating an LTOWB program, 47% (20/43) with interest but no current plan to develop a LTOWB program, and 30% (13/43) with no immediate interest in an LTOWB program. For the hospitals actively or imminently using LTOWB, 70% (3/10) have a minimum recipient weight criterion, 60% (6/10) have a minimum age criterion, and 70% (7/10) restrict the maximum volume transfused. Before the patient's RhD type becomes known, 30% (3/10) use RhD negative LTOWB for males and females, 40% (4/10) use RhD positive LTOWB for males and RhD negative LTOWB for females, 20% (2/10) use RhD positive LTOWB for males and RhD negative RBCs for females, and 10% (1/10) use RhD positive LTOWB for both males and females. Maximum LTOWB storage duration was 14–35 days and units nearing expiration were used for non‐trauma patients (40%), processed to RBC (40%), and/or discarded (40%). The most common barriers to implementation were concerns about inventory management (37%), wastage (35%), infrequent use (33%), cost (21%) and unclear efficacy (14%). Conclusion LTOWB utilization is increasing in pediatric level 1 trauma centers in the United States.

Blood Banking Considerations in Pediatric Trauma

“…[48][49][50] In an attempt to conserve group O/RhD-negative blood, many adult and pediatric trauma programs transfuse RhD-positive products before blood type is determined for males of any age. 51 Even during an MTP, blood products must be stored and transported in proper temperature to ensure safety and effectiveness and avoid waste (Table 1). Chain of custody must be documented, so all issued blood products can be accounted for at all times.…”

“…Some pediatric centers have opted to limit the maximum volume that any one patient can receive, while others have not. 51…”

“…After 14 days, as platelets and clotting factors degrade, some centers centrifuge unused LTOWB units, decant the plasma, and relabel the unit as RBCs, which optimizes hemostatic potential of LTOWB and overall resource utilization/cost. 51,69…”

“…High-quality data in adult military and civilian trauma confirm its safety and effectiveness 52,53 . More information is emerging in the pediatric arena 51,54,55 . A platelet-sparing leukoreduction filter can be used to decrease leukocyte burden but allow cold-stored, activated platelets to aid in hemostasis.…”

“…Low-titer group O whole blood units collected in CPD expire at 21 days, whereas LTOWB units collected in CPD adenine expire at 35 days, Table 1. After 14 days, as platelets and clotting factors degrade, some centers centrifuge unused LTOWB units, decant the plasma, and relabel the unit as RBCs, which optimizes hemostatic potential of LTOWB and overall resource utilization/cost 51,69 …”