World Journal of Surgery

, Volume 32, Issue 1, pp 2–6 | Cite as

Fresh Whole Blood Transfusions in Coalition Military, Foreign National, and Enemy Combatant Patients during Operation Iraqi Freedom at a U.S. Combat Support Hospital

  • Philip C. SpinellaEmail author
  • Jeremy G. Perkins
  • Kurt W. Grathwohl
  • Thomas Repine
  • Alec C. Beekley
  • James Sebesta
  • Donald Jenkins
  • Kenneth Azarow
  • John B. Holcomb
  • the 31st CSH Research Working Group



United States military doctrine permits the use of fresh whole blood (FWB), donated by U.S. military personnel on site, for casualties with life-threatening injuries at combat support hospitals. U.S. Military Medical Department policy dictates that all patients treated at military facilities during combat (coalition military personnel, foreign nationals, and enemy combatants) are to be treated equally. The objectives of this study were to describe admission vital signs and laboratory values and injury location for patients transfused with FWB, and to determine if FWB was employed equally among all patient personnel categories at a combat support hospital.


This retrospective cohort study evaluated admission vital signs and laboratory values, injury location, and personnel category for all patients receiving FWB at a U.S. Army combat support hospital in Baghdad, Iraq, between January and December 2004.


Eighty-seven patients received 545 units of FWB. Upon admission, the average (±S.D.) heart rate was 144 bpm (±25); systolic blood pressure, 106 mmHg (±33); base deficit, 9 (±6.5); hemoglobin, 9.0 g/dl (±2.6); platelet concentration, 81.9 × 103/mm3 (±81); international normalized ratio (INR), 2.0 (±1.1); and temperature 95.7°F (±2.6). The percentages of intensive care patients who received FWB by personnel category were as follows: coalition soldiers, 51/592 (8.6%); foreign nationals, 25/347 (7.2%); and enemy combatants, 11/128 (8.5% (p = 0.38). The amount of FWB transfused by personnel category was as follows: coalition soldier, 4 units (1–35); foreign national, 4 units (1–36); and enemy combatant, 4 units (1–11) (p = 0.9).


Fresh whole blood was used for anemic, acidemic, hypothermic, coagulopathic patients with life-threatening traumatic injuries in hemorrhagic shock, and it was transfused in equal percentages and amounts for coalition soldiers, foreign nationals, and enemy combatants.


Injury Severity Score Hemorrhagic Shock Abbreviate Injury Scale Foreign National Operation Iraqi Freedom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Col. Ruth Lee, LTC Emmett Gourdine, and the 31st CSH Research Working group (Drs. Jack Chiles, Lorne Blackbourne, Dennis Nichols, Jennifer Greco, Cynthia Clagett, and Gregory Thibault), for assistance with data collection; Amy Newland and Dr. Charles E. Wade, for support, helpful discussions, and critical evaluation of the manuscript. Philip C. Spinella, MD, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis


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Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Philip C. Spinella
    • 6
    • 7
    Email author
  • Jeremy G. Perkins
    • 2
  • Kurt W. Grathwohl
    • 1
  • Thomas Repine
    • 3
  • Alec C. Beekley
    • 4
  • James Sebesta
    • 4
  • Donald Jenkins
    • 5
  • Kenneth Azarow
    • 4
  • John B. Holcomb
    • 6
  • the 31st CSH Research Working Group
  1. 1.Brooke Army Medical CenterSan AntonioUSA
  2. 2.Walter Reed Army Medical CenterWashingtonUSA
  3. 3.William Beaumont Army Medical CenterEl PasoUSA
  4. 4.Madigan Army Medical CenterWashingtonUSA
  5. 5.Wilford Hall Air Force Medical CenterSan AntonioUSA
  6. 6.U.S. Army Institute of Surgical ResearchSan AntonioUSA
  7. 7.Connecticut Children’s Medical CenterHartfordUSA

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