Whole Blood Transfusion

Key points

Introduction

In World War II, the Korean War, and the Vietnam War, whole blood was used by the military in combat. Crystalloids, colloids, and component therapy eventually replaced the use of whole blood. Civilian transfusion services transitioned to component therapy in the 1970s to 1980s. Component therapy allows each donated whole blood unit to be stored as separate components for varying lengths of time for future use. Component therapy also maximizes the ability of each donated whole blood unit to aid as many patients as possible by division into components followed by treatment of specific hematologic deficits. In the early 2000s, the conflicts in Iraq and Afghanistan brought about changes in resuscitation of patients with traumatic hemorrhagic shock. Since then, balanced ratios of components used to recapitulate whole blood have been used in damage control resuscitation, with many hospitals implementing massive transfusion protocols to deliver balanced components to massively bleeding patients. The US military has used warm fresh whole blood since 2004 and has also recently started using cold-stored low-titer group O whole blood as well. 1234567 Utilization of whole blood in military trauma medicine has led to interest in whole blood by the civilian trauma community. ⁸ In civilian medicine, whole blood is not always available and is not used universally. 9101112

Whole blood may be used in the setting of symptomatic anemia with blood volume loss in order to increase oxygen-carrying capacity and blood volume. If a specific blood component can be used to treat a specific deficit, component therapy is preferred over whole blood. 131415 Whole blood use has been described in the medical management of military trauma patients, civilian trauma patients, pediatric surgical patients, patients with postpartum hemorrhage, and in resource-poor settings where evacuation cannot occur in a timely manner. This article focuses primarily on whole blood transfusion in US civilian patient populations.

Whole blood may be stored at 1°C to 6°C for up to 21 days in CPD/CP2D or up to 35 days in CPDA-1. If the product is irradiated, it expires on either the original expiration date or 28 days from irradiation (the sooner of the 2 dates). It may be transported at 1°C to 10°C. ¹⁶ Although previous editions of the AABB Standards for Blood Banks and Transfusion Services have specified that group-specific whole blood must be used, the current AABB Standards for Blood Banks and Transfusion Services (32nd edition, 2020) specify that ABO group–specific whole blood or low-titer group O whole blood may be transfused. Standard 5.27.1.1 specifies that transfusion services that use low-titer group O whole blood shall define low titer and shall have policies, processes, and procedures for “the use of low-titer group O Whole Blood” and for “the maximum volume/units allowed per event.” ¹⁶ A national standard for titers has not been established, and practices now vary among institutions. ^2 , 9