ABSTRACT
INTRODUCTION
Resuscitation of severely injured trauma patients is commonly performed using red
blood cells in additive solution supplemented with plasma and platelet concentrates.
There is an increasing interest in the use of low anti-A titer Group O whole blood
(LTOWB) in the early management of the resuscitation. It is unclear whether clinical
outcome is improved using this approach.
METHODS
Expired units of CPD-LTOWB were studied on Day 22 and expired units of thawed plasma
on Day 6 and Day 7. LTOWB was assessed for hemoglobin content, clotting factor levels
and platelet numbers and function using thromboelastography ( TEG) and impedance aggregation.
Assays of fibrinogen and FV, FVIII, FVII and FX were performed on the expired plasma.
The LTOWB hemoglobin was compared to red cells in additive solution (AS-RBCs) and
the clotting factor levels to those of expired thawed plasma. Platelet function was
compared to fresh whole blood samples from healthy subjects.
RESULTS
LTOWB contained slightly more hemoglobin than the AS-RBCs (Medians, 66 v 59 G), and the plasma content of fibrinogen was similar. Other clotting factors were
reduced by approximately 15% except for FVIII which was 30% less. Both TEG and impedance
aggregometry showed evidence of residual platelet function despite the prolonged period
of refrigerator storage.
CONCLUSION
LTOWB contains higher hemoglobin and adequate clotting factors, and residual platelet
function is demonstrated indicating that this product would be expected to be at least
equivalent to a single unit of each of the conventional components commonly used in
trauma resuscitation.
Keywords
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REFERENCES
- Some immunohematologic results of large transfusion of group O blood in recipients of other blood groups: A study of battle casualties in Korea.Blood. 1954; 9: 103-116
- Status of use of universal donor blood transfusion. Crit Rev.Clin Sci. 1973; 4: 147-160
- Un-cross-matched blood for emergency transfusion.One year’s experience in a civilian setting. JAMA. 1978; 240: 2057-2059
- Resuscitation of trauma patients with type-specific uncrossmatched blood.J Trauma. 1984; 24 (327-231)
- Seven years’ experience with group O unmatched packed red blood cells in a regional trauma unit.Ann Emerg Med. 1987; 16: 1344-1349
- Immediate trauma resuscitation with type O uncrossmatched blood: a two-year prospective experience.J Trauma. 1986; 26: 897-902
- Clinical usefulness of red cells preserved in protein poor mediums. New Eng.J Med. 1978; 299: 1377-1382
- Red-cell suspensions.N Engl J Med. 1979; 300 (984–598)
- Red Cell suspensions. New Eng.J Med. 1979; 300: 984
- Red cells for transfusion.N Engl J Med. 1978; 299 (1411–1142)
- Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients.Ann Surg. 2008; 248: 447-458
- The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital.J Trauma. 2007; 63: 805-813
- Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial.JAMA. 2015; 313: 471-482
- Warm fresh whole blood is independently associated with improved survival for patients with combat related traumatic injuries.J Trauma. 2009; 66: S69-S76
- Back to the Future: The Renaissance of whole -blood transfusions for massively hemorrhaging patients.Surgery. 2014; 155: 883-886
- Whole blood for the acutely haemorrhaging civilian trauma patients: a novel idea or rediscovery?.Transfus Med. 2016; 26: 406-414
- The US military experience with fresh whole blood during the conflicts in Iraq and Afghanistan.Semin Cardiothorac Vasc Anesth. 2012; 16: 153-159
- Whole blood: back to the future.Curr Opin Hematol. 2016; 23: 536-542
- Whole blood for hemostatic resuscitation of major bleeding.Transfusion. 2016; 56: S190-S202
- Whole blood: the future of traumatic hemorrhagic shock resuscitation.Shock. 2014; 41: 62-69
- Clinical outcomes among low-titer group O whole blood recipients compared to recipients of conventional components in civilian trauma resuscitation.Transfusion. 2018; 58: 1838-1845
- Give the trauma patient what they bleed, when and where they need it: establishing a comprehensive regional system of resuscitation based on patient need utilizing cold-stored, low-titer O+ whole blood.Transfusion. 2019; 59: 1429-1438
- Injured recipients of low-titer group O whole blood have similar clinical outcomes compared to recipients of conventional component therapy: A single-center, retrospective study.Transfusion. 2021; 61: 1710-1720
- The use of low-titer Group O whole blood is independently associated with improved survival compared to component therapy in adults with severe traumatic hemorrhage.Transfusion. 2020; 60: S2-S9
- Platelet function in platelet concentrates and in whole blood.Anaesth Intensive Care. 1985; 13: 355-361
- Cold-Stored Platelets: Review of Studies in Humans.Transfus Med Rev. 2020; 34: 221-226
- Physiology of cold-stored platelets.Transfus Apher Sci. 2019; 58: 12-15
- In vitro measurements of platelet concentrates stored at 4 and 22 degree C: correlation with posttransfusion platelet viability and function.Vox Sang. 1981; 40: 72-86
- A comparison of platelet function in cold-stored whole blood and platelet concentrates.Transfusion. 2021; 61: 3224-3235
- Whole blood haemostatic function throughout a 28-day cold storage period: an.in vitro study. Vox Sang. 2021; 116: 190-196
- Quality of platelets in stored whole blood.Trans Med Rev. 2020; 34: 234-241
- An in vitro study of coagulation properties in refrigerated whole blood and reconstituted whole blood.Vox Sang. 2019; 114: 694-700
- Hemolysis in in-date RBC concentrates.Am J Clin Pathol. 2017; 20: 35-41
- Effects of platelet-sparing leukocyte reduction and agitation methods on in vitro measures of hemostatic function in cold-stored whole blood.J Trauma Acute Care Surg. 2018; 84: S104-S114
- Hemostatic properties of cold-stored whole blood leukoreduced using a platelet-sparing versus a non–platelet-sparing filter.Transfusion. 2019; 59: 1809-1817
- Ristocetin induced platelet aggregate formation and adherence to the probe of an impedance aggregometer.Am J Clin Path. 1990; 93: 548-551
- Whole blood aggregation in von Willebrand disease.Am J Hematol. 1989; 32: 190-193
- Injured recipients of low titer Group O whole blood have similar outcomes compared to recipients of conventional component therapy: a single center retrospective study.Transfusion. 2021; 61: 1710-1720
Article info
Publication history
Accepted:
August 23,
2022
Received in revised form:
August 4,
2022
Received:
May 27,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.