Re‐introducing whole blood for transfusion: considerations for blood providers

Abstract

Whole blood is the original blood preparation but disappeared from the blood bank inventories in the 1980s following the advent of component therapy. In the early 2000s, both military and civilian practice called for changes in the transfusion support for massive haemorrhage. The ‘clear fluid’ policy was abandoned and replaced by early balanced transfusion of platelets, plasma and red cells. Whole blood is an attractive alternative to multi‐component therapy, which offers reduced hemodilution, lower donor exposure and simplified logistics. However, the potential for wider re‐introduction of whole blood requires re‐evaluation of haemolysins, storage conditions and shelf‐life, the need for leucocyte depletion/ pathogen reduction and inventory management for blood providers. This review addresses these questions and calls for research to define the optimal whole blood product and the indications for its use.

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

“…Several large, randomized trials in different countries are planned and will provide definitive answers about the efficacy of LTOWB, but it is clear that LTOWB simplifies the logistics of the resuscitation and is a more concentrated product compared to conventional components, amongst many other benefits. 21,25,52 Cost/Unable to obtain LTOWB • Continue to request it from your blood supplier. LTOWB use is increasing in the USA and blood centers are becoming more willing to supply it.…”

Haematological management of major haemorrhage: a British Society for Haematology Guideline

“…[127][128][129] Coldstored low-titre type O whole blood is under investigation in the UK and has a shorter shelf life (14-21 days) than RBCs in optimal additive solutions. 130 Finally, extending the use of blood for major traumatic haemorrhage into the pre-hospital environment may seem clinically intuitive, 131 but has significant implications for transfusion laboratory services at a local and national level. 131 Such challenges include the demand for use of 'universal' blood group components, the potential for wastage, and the need for regulatory compliance and associated workload.…”

Minimal impact of anticoagulant on in vitro whole blood quality throughout a 35‐day cold‐storage regardless of leukoreduction timing

“…The re‐discovery of whole blood (WB) as a potentially preferred transfusion product for treating actively bleeding patients is evident by the number of recent publications on this topic 1–4 . Although WB was used for transfusion prior to the introduction of blood component therapy, its widespread return to the formularies of blood suppliers and use in transfusion medicine remains a “work‐in‐progress.” 5,6 Clinical studies are currently underway to assess efficacy of WB versus component therapy Many studies have now been published demonstrating its safety and efficacy in trauma transfusion, and its potential benefits for prehospital treatment in both military and civilian settings 8–10 . More recent studies have begun looking at its use in an expanded patient population, specifically nontrauma patients 7 …”

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