The Use of Fresh Whole Blood in Massive Transfusion

Repine, Thomas B.; Perkins, Jeremy G.; Kauvar, David S.; Blackborne, Lorne

doi:10.1097/01.ta.0000219013.64168.b2

Cited by 197 publications

(186 citation statements)

References 49 publications

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“…36 The indications for the use of plasma have been determined by estimates of plasma protein requirements based on calculation, animal studies, and clinical experience during the time when stored whole blood was primarily transfused. 37 Standard indications for the use of plasma have included either a 1 to 2 blood volume loss or an INR greater than 1.5 times above normal in a patient with active bleeding.…”

Section: Discussionmentioning

confidence: 99%

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

Spinella

Perkins

Grathwohl

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

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159

108

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Section: Discussionmentioning

confidence: 99%

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

Spinella

Perkins

Grathwohl

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

Self Cite

159

108

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“…8 When the fractionation of blood products was developed around World War II, treatment with BCT became the standard primarily because of the ease of storage and the ability to elicit specific effects (eg, packed red cells for low hematocrit). 9 This change to component therapy occurred without robust research aimed at comparing health outcomes between FWB and BCT. 9,10 Additionally, guidelines from the Food and Drug Administration regarding blood storage are based on red blood cell (RBC) membrane integrity and adenosine triphosphate levels within the cell and not on oxygen delivery to the tissues.…”

Section: Hemorrhage Transfusion Practicesmentioning

confidence: 99%

“…9 This change to component therapy occurred without robust research aimed at comparing health outcomes between FWB and BCT. 9,10 Additionally, guidelines from the Food and Drug Administration regarding blood storage are based on red blood cell (RBC) membrane integrity and adenosine triphosphate levels within the cell and not on oxygen delivery to the tissues. 11 These concerns regarding the safety and effectiveness of transfusing older blood products as well as the lack of clinical outcomes to demonstrate the superiority or even equivalence of BCT to whole blood has resulted in a renewed interest in FWB therapy.…”

Section: Hemorrhage Transfusion Practicesmentioning

confidence: 99%

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Fresh Whole Blood Transfusion: Military and Civilian Implications

Goforth

Tranberg

Boyer³

et al. 2016

Critical Care Nurse

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Uncontrolled hemorrhage and exsanguination are the leading cause of preventable death, and resuscitative therapy is a critical component for survival. In various combinations, fresh whole blood, blood components, colloids, and crystalloids have all been staples of trauma care. The use of fresh whole blood is a well-established military practice that has saved the lives of thousands of American and coalition military personnel. Civilian use of fresh whole blood is far less established owing to the wide availability of individual blood components. However, this highly tailored blood supply is vulnerable to both natural and man-made disasters. In the event of such disruption, such as a major hurricane, it may be necessary for civilian hospitals to rapidly enact a fresh whole blood program. Therefore, the aim of this article is to review the current use of blood therapy for trauma resuscitation, the US military's approach to fresh whole blood, and how maintaining a civilian capacity for fresh whole blood collection in the event of future man-made and natural disasters is key to promoting survival from trauma. (Critical Care Nurse. 2016; 36[3] 1 Hemorrhage, in turn, quickly leads to hypoperfusion, or "shock," and coagulopathy.2 Death due to hemorrhage occurs soon after trauma, usually within the first 6 hours of hospital admission.3,4 US hospital data on trauma patients indicates that coagulopathy, which is associated with early mortality, occurs in 28% of hospital admissions.5 Determining which patients are at risk of shock and coagulopathy developing and applying resuscitation strategies to prevent these processes directly improve survival. 6 In various combinations, fresh whole blood (FWB), blood component therapy (BCT), colloids, and crystalloids have all been staples of trauma care. Therefore, our aim is to review the current use of blood therapy for trauma resuscitation and the US military's approach to FWB. This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Compare and contrast the evidence regarding the transfusion of fresh whole blood 2. Describe the application of fresh whole blood transfusion in the event of a man-made or natural disaster 3. Describe the steps and supplies necessary for the safe collection of fresh whole blood To complete evaluation for CE contact hour(s) for test #C163, visit www.ccnonline.org and click the "CE Articles" button. No CE test fee for AACN members.

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“…[6] Massive transfusion may increase risk of hemorrhage due to presence of anticoagulants and high levels of preservative solutions, which may lead to dilutional coagulopathy within the first 24 hours. [7] WFWB has the several advantages. Risk of hypothermia is reduced, oxygen delivery capacity is maintained in RBCs, and platelets and coagulation factors can be preserved for up to 72 hours.…”

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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The Use of Fresh Whole Blood in Massive Transfusion

Abstract: Under extreme and austere circumstances, the risk:benefit ratio of whole blood transfusion favors its use. Fresh whole blood may, at times, be advantageous even when conventional component therapy is available.

Cited by 197 publications

References 49 publications

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

Fresh Whole Blood Transfusion: Military and Civilian Implications

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

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