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

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgments

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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Authors and Affiliations

  1. Brooke Army Medical Center, San Antonio, Texas, USA

    Kurt W. Grathwohl

  2. Walter Reed Army Medical Center, Washington, D.C., USA

    Jeremy G. Perkins

  3. William Beaumont Army Medical Center, El Paso, Texas, USA

    Thomas Repine

  4. Madigan Army Medical Center, Washington, Tacoma, USA

    Alec C. Beekley, James Sebesta & Kenneth Azarow

  5. Wilford Hall Air Force Medical Center, San Antonio, Texas, USA

    Donald Jenkins

  6. U.S. Army Institute of Surgical Research, San Antonio, Texas, USA

    Philip C. Spinella & John B. Holcomb

  7. Connecticut Children’s Medical Center, Hartford, CT, USA

    Philip C. Spinella

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  1. Philip C. Spinella
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  2. Jeremy G. Perkins
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  3. Kurt W. Grathwohl
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  4. Thomas Repine
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Correspondence to Philip C. Spinella.

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The views and opinions expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Army Medical Department, Department of the Army, the Department of Defense, or the United States Government.

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Spinella, P.C., Perkins, J.G., Grathwohl, K.W. et al. Fresh Whole Blood Transfusions in Coalition Military, Foreign National, and Enemy Combatant Patients during Operation Iraqi Freedom at a U.S. Combat Support Hospital. World J Surg 32, 2–6 (2008). https://doi.org/10.1007/s00268-007-9201-5

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