A comparison between leukocyte reduced low titer whole blood vs non‐leukocyte reduced low titer whole blood for massive transfusion activation

Abstract

Background: Hemorrhagic shock is the leading cause of survivable death in trauma patients and recent literature has focused on resuscitation strategies including transfusing low-titer group O whole blood (LTOWB). Debate remains regarding whether leukocyte reduced (LR) whole blood is of clinical benefit or detriment to patients requiring massive transfusion. This study compares survival outcomes between LR-LTOWB and non-LR LTOWB. Study Design and Methods: The objective of this prospective, observational study was to detect any difference in 24-hour survival between patients receiving LR-LTOWB and non-LR LTOWB during their massive transfusion activation. Secondary objectives were to report any difference in ICU LOS, ventilation days, in-hospital survival, and hospital LOS. Data collected included patient sex, age, mechanism of injury, Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), cause of death, and number of LTOWB transfused. Results: A total of 167 patients received 271 LTOWB transfusions. There were 97 patients that received 168 units of LR-LTOWB while 70 patients received 103 units of non-LR LTOWB. The two study groups were comparable in terms of age, sex, ISS, TRISS, and the number of LTOWB transfused. The use of LR LTOWB during the initial massive transfusion activation in traumatically injured patients was not associated with increased 24-hour survival compared to when using non-LR LTOWB. No transfusion associated adverse events were reported. Conclusions: The administration of either LR or non-LR LTOWB was not associated with >24 hours survival in patients presenting with massive hemorrhage. The high cost and the rapid decline in platelet count of LR whole blood may be a consideration.

A comparison between liquid group A plasma and thawed group A plasma for massive transfusion activation in trauma patients

“…Group A LP units and TP units, received as plasma frozen within 24 h, were obtained from the American Red Cross blood services division. All plasma units were collected from only male donors to comply with the transfusion‐related acute lung injury risk mitigation requirement [9]. All LP units were stored between 1 and 6°C for a maximum of 26 days.…”

Civilian walking blood bank emergency preparedness plan

“…Continue with local standard practice and supplies, knowing that not all centers utilize this approach. Leucocyte reduction, while standard in many countries, is not universally utilized in WB transfusion, and recent data suggest it may impair platelet function and clinical outcome 39 . In a time‐ and resource‐limited situation, it is likely and acceptable for the Medical Director to waive this requirement. …”

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

“…Length of storage time for whole blood remains debated, although data show significant degradation of the hemostatic potential of whole blood after 14 days of storage [ 121 ]. Leukoreduction of LTOWB does not appear to afford any distinct clinical benefit over non-leukoreduced units [ 122 ]. Additionally, resuscitation with whole blood may be a better option for exsanguinating hemorrhage in certain parts of the world where there is a lack of well-equipped blood banks and insufficient availability of blood products [ 123 ].…”