The Indications for Transfusion of Freshly Drawn Blood

The Use of Fresh Whole Blood in Massive Transfusion

“…6,7,10,25 Continued use of whole blood in military environments has been necessary because of the lack of platelets and frozen components in the theater of war-a problem not seen in civilian settings. Platelets, separated from whole blood by centrifugation or harvested by apheresis, must be maintained at room temperature (20 -24°C) with continuous agitation, and even then they are only viable for 5 days of storage.…”

“…The procedure was a valuable adjunct to supply but did add complexity in the consideration of exactly what components of each whole blood unit remained effective after periods of storage. 7 These concerns are summarized in Table 2.…”

“…6 The advent of whole blood fractionation techniques in the decades after WWII suggested that blood could be used more efficiently if the donated whole blood was separated into packed red blood cells (RBCs), fresh frozen plasma (FFP), platelet concentrates, and cryoprecipitate. 7,8 Separate components were felt to maximize the potential for rational utilization of each donated unit while simultaneously limiting unnecessary transfusions, with their attendant risk of infection and transfusion reaction. 9 As a result of component therapy, the use of whole blood fell out of favor in the civilian community, and current civilian indications for the use of whole blood are increasingly narrow (Table 1).…”

“…However, both civilian and military physicians continued to investigate the indications and use of whole blood in the setting of massive transfusion. 7,10,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]44 The clinical situations in which any of these levels of transfusion are needed are imminently life-threatening.…”

The coagulopathy of cardiopulmonary bypass

“…The blood transfusion requirements have changed remarkably from when whole blood was used as routine priming for CPB in the 1950s 1,2 . Approximately 70% of CPB procedures can now be performed without using allogeneic blood.…”