Whole Blood is Superior to Component Transfusion for Injured Children

Abstract

Objective: To compare a propensity-matched cohort of injured children receiving conventional blood component transfusion to injured children receiving low-titer group O negative whole blood. Summary of Background Data: Transfusion of whole blood in pediatric trauma patients is feasible and safe. Effectiveness has not been evaluated. Methods: Injured children ≥1 years old can receive up to 40 mL/kg of cold-stored, uncrossmatched whole blood during initial hemostatic resuscitation. Whole blood recipients (2016–2019) were compared to a propensity-matched cohort who received at least 1 uncrossmatched red blood cell unit in the trauma bay (2013–2016). Cohorts were matched for age, hypotension, traumatic brain injury, injury mechanism, and need for emergent surgery. Outcomes included time to resolution of base deficit, product volumes transfused, and INR after resuscitation. Results: Twenty-eight children who received whole blood were matched to 28 children who received components. The whole blood group had faster time to resolution of base deficit [median (IQR) 2 (1–2.5) hours vs 6 (2–24) hours, respectively; P < 0.001]. The post-transfusion INR was decreased in whole blood vs component cohort [median (IQR) 1.4 (1.3–1.5) vs 1.6 (1.4–2.2); P = 0.01]. Lower plasma volumes [median (IQR) = 5 (0–15) mL/kg vs 11 (5–35) mL/kg; P = 0.04] and lower platelet volumes [median (IQR) = 0 (0–2) vs 3 (0–8); P = 0.03] were administered to the whole blood group versus component group. Other clinical variables (in-hospital death, hospital length of stay, intensive care unit length of stay, and ventilator days) did not differ between groups. Conclusions: Compared to component transfusion, whole blood transfusion results in faster resolution of shock, lower post-transfusion INR, and decreased component product transfusion. Larger cohorts are required to support these findings.

Survey to inform trial of low‐titer group O whole‐blood compared to conventional blood components for children with severe traumatic bleeding

“…A 50% reduction in mortality can be calculated when LTOWB is used for children with life-threatening traumatic bleeding compared to components based on the data recently published by Leeper and colleagues. 12 In summary, while the specifics of a sample size analysis can be debated, it is feasible to enroll at least 900 children over a 4 year period at 20 centers based on our survey results.…”

Safety profile of low‐titer group O whole blood in pediatric patients with massive hemorrhage

“…Note that outcomes and other data on some of these patients had been published previously. 16,23,24 Platelets 0 (0-5) 0 (0-4) .95…”

“…[12][13][14] Furthermore, emerging data suggest that LTOWB has additional advantages compared to conventional blood components for trauma resuscitation, including faster resolution of shock, lower post-transfusion INR values, reduced transfusion requirements following the initial resuscitation, and improved survival. [15][16][17] One safety consideration when transfusing LTOWB is the risk of an acute hemolytic reaction, as the anti-A and anti-B that are passively transfused along with the LTOWB could cause hemolysis in non-group O recipients. However, this risk can be mitigated by selecting units with low titers of anti-A and B.…”

Effects of pathogen reduction technology and storage duration on the ability of cryoprecipitate to rescue induced coagulopathies in vitro

“…Mortality at 28 days is high in patients with severe traumatic hemorrhage, ranging between 20% and 24% in adults 1,2 and 36% and 50% in children 3,4 . Impaired fibrinogen function is highly associated with mortality in these patients with traumatic bleeding, 5,6 and transfusion of fibrinogen‐containing products may improve outcomes 7–10 .…”