Use of Uncrossmatched Cold-Stored Whole Blood in Injured Children With Hemorrhagic Shock

Abstract

No transfusion reactions were reported. The median (IQR) time from ED admission to the start of the WB transfusion was 15 (14-77) minutes, compared with 303 (129-741) minutes (P < .001) for administration of at least 1 unit of RBCs, plasma, and platelets in the historical cohort (Figure).Discussion | To our knowledge, this is the first cohort of pediatric civilian trauma patients to receive WB during resuscitation. These preliminary data suggest that WB transfusion of up to 20 mL/kg is safe in children with severe injuries; there was no evidence of hemolysis in non-group O recipients, and no transfusion reactions were reported. Based on these data, the transfusion committee of Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center approved an increase in maximum volume of WB transfusion to 30 mL/kg. Larger cohorts are necessary for further study to determine if WB administration will affect outcomes, including number of donor exposures, cost, total volume transfused, and mortality.

Clinical outcomes among low‐titer group O whole blood recipients compared to recipients of conventional components in civilian trauma resuscitation

“…It was recently demonstrated that using LTOWB in pediatric trauma patients led to significantly faster transfusion of one dose of RBCs, plasma, and PLTs compared to using conventional components. 20 The higher median plasma and PLT utilization among the LTOWB patients compared to the conventional component therapy group was likely a reflection of the obligatory transfusion of a plasma and PLT unit for every LTOWB unit transfused as opposed to an increased clinical need for these products in these patients. At this institution the LTOWB units are selected to have titers of anti-A and -B of 50 or less; this titer was selected to minimize the risk of hemolysis, although higher titers such as less than 256 have been suggested to also be safe for nongroup O LTOWB recipients.…”

“…Evidence for this latter assertion is demonstrated by the higher plasma:RBC and PLT:RBC ratios among the LTOWB recipients; the equal‐blood product ratio contribution from LTOWB was an important factor in achieving this important end, especially in the early phase of the resuscitation. It was recently demonstrated that using LTOWB in pediatric trauma patients led to significantly faster transfusion of one dose of RBCs, plasma, and PLTs compared to using conventional components . The higher median plasma and PLT utilization among the LTOWB patients compared to the conventional component therapy group was likely a reflection of the obligatory transfusion of a plasma and PLT unit for every LTOWB unit transfused as opposed to an increased clinical need for these products in these patients.…”

The use of low‐titer group O whole blood for the resuscitation of civilian trauma patients in 2018

“…Another hospital uses LTOWB units for trauma patients for up to 21 days; after that time, they can be used for up to 35 days for other bleeding patients such as those in the operating room (listed as “other” for Question 8 in Table ). One American hospital and the Norwegian hospital offer LTOWB for use in traumatically injured children; the American hospital requires that potential pediatric recipients of LTOWB be at least 3 years old and at lease 15 kg, while the Norwegian hospital does not have any limits on qualifying pediatric recipients. Finally, most respondents (10/16, 63%) perform some degree of laboratory monitoring for hemolysis amongst the LTOWB recipients (see Question 12 in Table ), including one hospital that measures the plasma hemoglobin concentration and performs a peripheral blood film along with a complete blood count on their LTOWB recipients.…”

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

“…Interestingly, of the 10 respondents from pediatric trauma programs, the TM physicians overwhelmingly (9 of 10 [90%]) stated that they would not use WB for pediatric resuscitation, citing lack of sufficient published evidence. There are no prospective studies of transfusion resuscitation in pediatric trauma and very limited data showing the safety of LTOWB in children in the setting of hemorrhagic shock . The survey responses we received suggested that most TM physicians were not ready to extrapolate from the larger adult literature with respect to use of WB in trauma for this population.…”

“…There are no prospective studies of transfusion resuscitation in pediatric trauma 25 and very limited data showing the safety of LTOWB in children in the setting of hemorrhagic shock. 26 The survey responses we received suggested that most TM physicians were not ready to extrapolate from the larger adult literature with respect to use of WB in trauma for this population. However, because data supporting balanced component use in children are also lacking, 27 it remains to be seen whether practical considerations like being able to titrate volumes more accurately with WB, are included in the decision of whether to put LTOWB into pediatric MTPs.…”