Abstract
Whole blood transfusion was the standard for treatment of hemorrhagic shock until the development of component blood products in the 1960s, with subsequent shift of transfusion practice to nearly exclusively involve component blood products. Over the last 15 years there has been renewed interest in the possible benefits of whole blood compared to component blood transfusions for the treatment of traumatic hemorrhage. While most of the literature to date stems from recent military conflicts, there is increasing use of whole blood in the United State civilian trauma system. However, the majority of the literature remains observational in nature. Questions regarding the impact of whole blood on relevant clinical outcomes including mortality and multi-system organ failure have not been rigorously addressed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Yazer MH, Cap AP, Spinella P. Raising the standards on whole blood. J Trauma Acute Care Surg. 2018;84:S14–7. https://doi.org/10.1097/TA.0000000000001778.
Cap AP, Beckett A, Benov A, et al. Whole blood transfusion. Mil Med. 2018;183:44–51. https://doi.org/10.1093/milmed/usy120.
Crowe E, DeSantis SM, Bonnette A, et al. Whole blood transfusion versus component therapy in trauma resuscitation: a systematic review and meta-analysis. J Am Coll Emer Phys Open. 2020;1(4):633–41. https://doi.org/10.1002/emp2.12089.
Cotton B, Podbielski J, Camp E, et al. A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions. Ann Surg. 2012;258:527–233. https://doi.org/10.1097/SLA.0b013e3182a4ffa0.
Seheult JN, Anto V, Alarcon LJ, et al. Clinical outcomes among low-titer group O whole blood recipients compared to recipients of conventional components in civilian trauma resuscitation. Transfusion. 2018;58:1838–45. https://doi.org/10.1111/trf.14779.
Jones AR, Frazier SK. Increased mortality in adult patients with trauma transfused with blood components compared with whole blood. J Trauma Nurs. 2014;21(1):22–9. https://doi.org/10.1097/JTN.0000000000000025.
Nessen SC, Eastridge BJ, Cronk D, et al. Fresh whole blood use by forward surgical teams in Afghanistan is associated with improved survival compared to component therapy without platelets. Transfusion. 2013;53:107S–1113S. https://doi.org/10.1111/trf.12044.
Auten JD, Lunceford NL, Horton JL, et al. The safety of early fresh, whole blood transfusion among severely battle injured at US Marine Corps forward surgical care facilities in Afghanistan. J Trauma Acute Care Surg. 2015;79(5):790–6. https://doi.org/10.1097/TA.0000000000000842.
Perkins JG, Cap AP, Spinella PC, et al. Comparison of platelets transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients. Transfusion. 2011;51:242–52. https://doi.org/10.1111/j.1537-2995.2010.02818.x.
Spinella PC, Perkins JG, Grathwohl KW, et al. Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. J Trauma. 2009;66:S69–76. https://doi.org/10.1111/trf.14415.
Yazer MH, Jackson B, Sperry JL, et al. Initial safety and feasibility of cold-stored uncrossmatched whole blood transfusion in civilian trauma patients. J Trauma Acute Care Surg. 2015;81(1):21–6. https://doi.org/10.1097/TA.0000000000001100.
Kauvar DS, Holcomb JB, Norris GC, et al. Fresh whole blood transfusion: a controversial military practice. J Trauma. 2006;61:181–4. https://doi.org/10.1097/01.ta.0000222671.84335.64.
Zhu CS, Pokorny DM, Eastridge BJ, et al. 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;59:1429–38. https://doi.org/10.1111/trf.15264.
Ho KM, Leonard AD. Lack of effect of unrefrigerated young whole blood transfusion on patient outcomes after massive transfusion in a civilian setting. Transfusion. 2011;51:1669–75. https://doi.org/10.1111/j.1537-2995.2010.02975.x.
Trauma Hemostasis Oxygenation Research (THOR) Network. Emergency release low titer group O whole blood is now permitted by the AABB standards. [Press Release] 7 January. 2018. Available at https://rdcr.org/press-release-emergency-release-low-titer-group-o-whole-blood-now-permitted-aabb-standards/. Accessed 30 Sep 2020.
Cordier PY, Bélot-De Saint Leger F, Bégué S, Peytel É, Martinaud C. Cost-effectiveness improvement in trauma bleeding management: whole blood transfusion might also be considered! Anaesth Crit Care Pain Med. 2019;38(6):657–8. https://doi.org/10.1016/j.accpm.2019.06.002. Epub 2019 Jun 13
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Frasier, L.L., Benjamin, A.J., Schwab, C.W., Cannon, J.W. (2022). Difficult Decisions in Trauma Surgery: What Is the Clinical Impact of Whole Blood as Compared to Component Therapy in Civilian Trauma?. In: Wilson, K., Rogers, S.O. (eds) Difficult Decisions in Trauma Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-81667-4_2
Download citation
DOI: https://doi.org/10.1007/978-3-030-81667-4_2
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-81666-7
Online ISBN: 978-3-030-81667-4
eBook Packages: MedicineMedicine (R0)