Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care

Abstract

IntroductionThe Netherlands Armed Forces use -80°C frozen red blood cells (RBCs), plasma and platelets combined with regular liquid stored RBCs, for the treatment of (military) casualties in Medical Treatment Facilities abroad. Our objective was to assess and compare the use of -80°C frozen blood products in combination with the different transfusion protocols and their effect on the outcome of trauma casualties.Materials and MethodsHemovigilance and combat casualties data from Afghanistan 2006–2010 for 272 (military) trauma casualties with or without massive transfusions (MT: ≥6 RBC/24hr, N = 82 and non-MT: 1–5 RBC/24hr, N = 190) were analyzed retrospectively. In November 2007, a massive transfusion protocol (MTP; 4:3:1 RBC:Plasma:Platelets) for ATLS® class III/IV hemorrhage was introduced in military theatre. Blood product use, injury severity and mortality were assessed pre- and post-introduction of the MTP. Data were compared to civilian and military trauma studies to assess effectiveness of the frozen blood products and MTP.ResultsNo ABO incompatible blood products were transfused and only 1 mild transfusion reaction was observed with 3,060 transfused products. In hospital mortality decreased post-MTP for MT patients from 44% to 14% (P = 0.005) and for non-MT patients from 12.7% to 5.9% (P = 0.139). Average 24-hour RBC, plasma and platelet ratios were comparable and accompanying 24-hour mortality rates were low compared to studies that used similar numbers of liquid stored (and on site donated) blood products.ConclusionThis report describes for the first time that the combination of -80°C frozen platelets, plasma and red cells is safe and at least as effective as standard blood products in the treatment of (military) trauma casualties. Frozen blood can save the lives of casualties of armed conflict without the need for in-theatre blood collection. These results may also contribute to solutions for logistic problems in civilian blood supply in remote areas.

Freezing expired platelets does not compromise in vitro quality: An opportunity to maximize inventory potential

“…There has been a resurgence in interest in cryopreservation of platelets over the past decade . Although CPPs have been transfused for prophylactic purposes, the most prevalent indication for CPPs has been the treatment of active bleeding . In the future, CPPs could represent one component in a multiproduct inventory where the choice of product is dictated by individual patient requirements.…”

Investigation of the quality of stored red blood cells after simulated air drop in the maritime environment

“…Various options for supplying blood products to distant military settings have been considered, including the use of frozen RBCs and frozen platelets (PLTs). A study by the Netherlands Armed Forces has shown that recovered frozen components are safe and as effective as standard blood components in the treatment of trauma casualties . The option can be successfully applied to the maritime environment; however, it requires a bespoke infrastructure.…”

The use of cryopreserved platelets in the treatment of polytraumatic patients and patients with massive bleeding

“…The early intervention with blood products contributes significantly to correction of coagulopathy and to the control of bleeding . The rapid administration of the whole spectrum of transfusion products is proven to have a positive impact on patient survival; therefore, most current transfusion protocols and hemostatic resuscitation procedures are based on the coadministration of red blood cells (RBCs) and plasma, supplemented with platelet transfusion …”

“…Use of CPs improves the logistics of maintaining and providing platelet products where and when fresh products are not available. The production of CPs is not technologically demanding, and they can be easily thawed and reconstituted …”