Making whole blood for trauma available (again): the American Red Cross experience

Young, Pampee P.; Borge, P. Dayand

doi:10.1111/trf.15166

Cited by 18 publications

(18 citation statements)

References 27 publications

(53 reference statements)

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“…AABB standards require the transfusion of LTOWB for non–group O patients, but do not specify what a “low titer” should be . Most hospital centers surveyed by the American Red Cross (ARC) in 2017 cited less than 200 as a preferred low‐titer cutoff, which is the current titer threshold for LTOWB units offered by the ARC . The included studies mostly used a lower titer of less than 50 (Table ).…”

Section: Discussionmentioning

confidence: 99%

“…Other studies, beyond the scope of this review, have examined the role of WB in trauma patients, including the use of WB in military settings, in vitro examinations of the hemostatic capability of WB, logistical guidance for starting a WB program, and guidance on product selection . Fresh warm WB studies provide a strong foundation to support the rationale for the civilian use of WB.…”

Section: Discussionmentioning

confidence: 99%

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Current state of whole blood transfusion for civilian trauma resuscitation

2020

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BACKGROUND Whole blood (WB) is rapidly emerging as the treatment modality of choice for the initial resuscitation of civilian trauma patients across the United States. The reemergence of WB has been rapid and driven in part by recognition of the importance of early plasma transfusion in the resuscitation process. STUDY DESIGN AND METHODS The study was designed as a critical analysis of the available literature on WB transfusion in civilian trauma patients. Studies were included if they reported on transfusion of cold‐stored WB used in a civilian setting and measured safety, feasibility, or a direct clinical outcome. RESULTS Examination of the available literature supports the feasibility and safety of WB used in treatment of civilian trauma patients. The evidence regarding clinical outcomes, particularly with direct comparison to equivalent doses of component therapy, is more limited. The literature is predominantly descriptive and retrospective in nature and limited by the heterogeneity of clinical WB protocols being used. Based on this limited data set, there are limited conclusions that can be used to definitely support or refute the clinical superiority of WB to component therapy. CONCLUSION Current literature supports the safety and feasibility of WB, but prospective randomized trials comparing WB to component therapy are needed to provide the definitive evidence on this topic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Current state of whole blood transfusion for civilian trauma resuscitation

2020

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“…In the pediatric population, the preference is for O-negative blood. 45 Initial reports of pediatric whole blood transfusion during trauma bay resuscitation indicate that up to 20mL/kg of warm whole blood administered as the initial transfusion is safe and effective. This experience with eighteen patients greater than 15 kg from the Children's Hospital of Pittsburgh allowed efficient delivery of a whole blood within 15 min of arrival without any transfusion-related complications.…”

Section: Whole Bloodmentioning

confidence: 99%

<p>Massive Transfusion Protocols for Pediatric Patients: Current Perspectives</p>

Evangelista¹,

Gaffley²,

Neff³

2020

JBM

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In adults, the use of balanced resuscitation and study of massive transfusion protocols have led to improved outcomes for patients and continues to be refined. In children, massive transfusion protocols require further development and study to assess efficacy. Standardization is needed as transfusions and activation of protocols still rely on physician discretion in most pediatric settings. Further research is required to define the pediatric trauma population that will benefit, when to activate these protocols and how to use adjuncts such as tranexamic acid or factor VII in resuscitation. In addition, future implementation of technology such as hemoglobin-based oxygen carriers to increase survival should be studied further in this subset of patients.

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“…Finding adequate numbers of O neg donors is challenging when only ~7% of the US population is O neg and further compounded by the fact that of the 38% of the US population that is eligible to donate, only a small number, <5%, actually do so 14 . We lose approximately 2%–5% of the eligible O neg donors used for LTOWB by restricting the ABO isohemagglutinin titer cutoff to <1:200 15 . There is an estimated further loss of 25% of the eligible donors due to TRALI mitigation (achieved by restricting donor base to males and never pregnant females) and an additional unknown loss due to excluding donors who have had aspirin in the last 48 h (Borge, D., unpublished data).…”

Section: Introductionmentioning

confidence: 99%

Conservation of Rh negative Low Titer O Whole Blood (LTOWB) and the need for a national conversation to define its use in trauma transfusion protocols

Troughton

Young

2021

Transfusion

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Low‐titer group O whole blood (LTOWB) use is growing steadily in the United States. Although the percentage of O negative LTOWB use by Red Cross hospitals has remained steady at ~23% over the last 2 years, this elevated use rate is twice that of O negative RBC components. Given the more restricted group O donor pool, this level of use will make it difficult to expand the use of this product. Evaluation of hospital practices regarding females of childbearing potential show significant variability with some hospitals transfusing O positive, with others choosing to restrict this population to O negative LTOWB or only O negative RBC component therapy. To ensure access of LTOWB to all patients who may benefit and to maintain sufficient supplies, we recommend developing standardized practice recommendations for its use.

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Making whole blood for trauma available (again): the American Red Cross experience

Cited by 18 publications

References 27 publications

Current state of whole blood transfusion for civilian trauma resuscitation

Current state of whole blood transfusion for civilian trauma resuscitation

<p>Massive Transfusion Protocols for Pediatric Patients: Current Perspectives</p>

Conservation of Rh negative Low Titer O Whole Blood (LTOWB) and the need for a national conversation to define its use in trauma transfusion protocols

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