Fresh Whole Blood Transfusion: A Controversial Military Practice

Abstract

The transfusion of fresh whole blood (FWB) for trauma-induced coagulopathy is unusual in civilian practice. However, US military physicians have used FWB in every combat operation since the practice was introduced in World War I and continue to do so during current military operations. We discuss our review of all blood products administered to US military casualties in Operation Iraqi Freedom (OIF) between March and December 2003. FWB transfusions were most frequent when demands for massive transfusions wiped out existing blood supplies. FWB patients had the highest blood product requirements; however, mortality did not differ significantly between FWB and non-FWB patients overall or for massively transfused patients. We review the current military practice of FWB transfusion in combat theaters and conclude that FWB transfusion is convenient, safe, and effective in certain military situations.

Bleeding management in remote environment: the use of fresh whole blood transfusion and lyophilised plasma

“…Since the wars in Afghanistan and Iraq the FWBT process was implemented again with an upgraded screening technique which lowers the risk of transmission of an infectious agent, and as Kauvar et al [1] stated "FWBT is convenient, safe, and effective in certain military situations". This onsite screening of collected FWB units with the use of rapid detection tests for HIV, HCV, and HBV was recommended by Spinella et al [5] as a standard process to minimize the risk of infectious agent transmission.…”

“…This excellent potency is most probably due to the perfect 1/1/1 ratio for plasma, red cells and platelets, the low dose of conservative additives and anticoagulants compare to units of blood bank products, and not using large amounts of RBC older than 14 days since storage time affects quality of cells [5]. A 500 mL warm FWB unit provides all blood components, including coagulation factors, unaltered and in right proportion and temperature (haematocrit 38-50%, 150,000-400,000 platelets per microliter, and 100% activity of clotting factors) compare to the 660 mL of a mix of 1 unit of RBC, with 1 unit of FFP, and 1 unit of platelet concentrate with a whole haematocrit of 29%, 88,000 platelets per microliter, and 65% coagulation factor activity [1].…”

“…These procedures were the only alternative in a remote environment where there is no access to certified blood products, because maintaining a blood bank would be both operationally difficult due to the short shelf life of blood products, most of them would expire on board, and also unethical due to the scarcity of blood products in general. Kauvar et al [1] reported an 87% to 94% wastage rate for Packed Red Blood Cells in Forward Surgical Teams actively engaged in support of combat operations, and we could expect a much higher wastage rate in commercial maritime operations.…”

Beneficial Effects of Melatonin on Oxidative Damage Observed During Whole Blood Storage.

“…1,2 However, whole blood is still used in some developing countries and has been used repeatedly by the military of developed countries in Somalia, Bosnia, Kosovo and Afghanistan to replace red blood cells (RBCs) when the supply chain could not keep up with local need. [3][4][5] At present, the most widely used protocol for the storage of whole blood is the collection of blood into anticoagulant solutions (typically citrate-dextrose-phosphate: CDP) and storage at 4 ± 2 0 C. The studies suggest that the quality (in terms of safety and efficiency) of blood decreases during the storage period. 6,7 The most dramatic changes that occur during storage include acidosis, 8,9 loss of function of cation pumps and consequent loss of intracellular potassium 10,11 and increased oxidative stress.…”

From Donor to Patient in 20 Minutes

“…3,4 Managing storage limitations, maintaining blood at required temperatures (outdoor day- conflicts when subcomponents such as platelets and frozen components were not available. 7 In Somalia, FWB was used after the entire supply of PRBCs was used, 8 and in the first Gulf War, FWB was used when platelet supplies were exhausted. 7 During combat operations, limitations and restrictions in blood products affect the decision of…”