Emergency transfusion with whole blood versus packed red blood cells: A study of 1400 patients

Abstract

Background Low‐titer group O whole blood (LTOWB) is increasingly used for emergency transfusion. We studied whether initial release of LTOWB compared with packed red blood cells (pRBCs) reduced overall blood requirements for patients needing emergency transfusion. Secondary outcomes examined included survival and non‐lethal adverse clinical outcomes. Study Design and Methods A retrospective, single‐center, before‐versus‐after study compared patients transfused with emergency‐release, uncrossmatched pRBC followed by component therapy (2016–2019) versus patients transfused with emergency‐release, uncrossmatched LTOWB followed by component therapy (2019–2022). Results Outcomes were available for 602 patients in the pRBC group versus 749 in the whole blood group. The two groups were similar for age, sex, race, estimated blood volume, ABO blood groups, and underlying diagnosis. Use of LTOWB was associated with increased blood product use at 24 h (4.0 (2.0–12.0) in pRBC group versus 6.5 (4.2–12.7) in LTOWB group, p < .0001) and at 7 days (5.5 (3.0–13.0) in pRBC group versus 7.3 (4.3–14.3) in LTOWB group, p < .0001). Initial use of LTOWB was not associated with improved 24 h or 30 day survival nor lower incidence of non‐lethal adverse clinical outcomes compared with pRBC. Discussion Our study showed a statistically significant increase in total blood use and blood acquisition costs for patients receiving initial emergency transfusion with LTOWB compared with pRBC. The initial use of LTOWB offered no advantage over component therapy for 30 day survival or selected non‐lethal adverse outcomes.

Assessing transfusion-related costs: More than just the price of blood

“…Nevertheless, any case outliers that required high-cost, high-volume transfusion support (presumably categorized in the CT group) may have erroneously skewed cost comparisons in favor of the LTO+ WB group. As such, these findings conflict with a recent study showing significantly increased total blood use and blood acquisition costs for patients receiving initial emergency transfusion with low-titer group O whole blood (LTOWB) compared with red blood cells 3 …”

Considering equality in transfusion medicine practice

“…The exclusion of high titre donors has been demonstrated to mitigate the risk of haemolysis and other non-lethal adverse outcomes among injured non-group O recipients of LTOWB, 3,4 and also in primarily non-trauma recipients. 5 Perhaps these observational studies were not large enough to detect haemolysis, but this argument further supports the notion that haemolysis is a very uncommon event. In any case, the most important question is not whether haemolysis occurs, but rather if it leads to adverse clinical consequences.…”

What's new in whole blood resuscitation? In the trauma bay and beyond

“…Retrospective analysis suggests that WB with or without component therapy costs less than component therapy alone based on timeliness of resuscitation and rapidity of hemostasis [45 ▪ ]. Indeed, WB costs less per patient and per volume infused in both adult and pediatric trauma patients who received WB vs. those who received component therapy, although others found no cost benefit [46 ▪ ,47]. The approach to LTOWB resuscitation in the author's institution is shown in detail in Fig.…”