Transfusion medicine
Transfusion therapy
Whole blood therapy

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Bryon Jackson, M.D.

Minor changes: 15 December 2020

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PubMed Search: Whole blood [TI] therapy review [PT]

Bryon Jackson, M.D.
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Cite this page: Jackson B. Whole blood therapy. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/transfusionmedwholeblood.html. Accessed January 23rd, 2021.
Definition / general
  • Cold, stored whole blood (WB) may be stored at 1 - 6°C for up to 35 days (should be distinguished from fresh, warm whole blood)
  • Group O whole blood is used primarily for the resuscitation of trauma patients with massive bleeding
Essential features
  • Used primarily in the treatment of trauma patients with massive bleeding
  • Group O units can be used emergently across patient ABO types, making it practical as the initial resuscitation product
  • Risk of hemolysis can be mitigated by using units that have low anti-A and anti-B titers
  • May be effective tool for prehospital transfusion
Terminology
  • CSWB: cold, stored whole blood
  • LTOWB: low titer group O whole blood
  • WFWB: warm, fresh whole blood
Pathophysiology
Clinical features
  • Delivers all components in a single product, providing early inclusion of plasma in trauma patients to address the coagulopathy of trauma (JAMA 2015;313:471)
  • Group O units can be used emergently across patient ABO blood types, making it practical as the initial resuscitation product in appropriate patients
  • May be effective tool for prehospital transfusion (JAMA Surg 2016;151:15)
  • Patients should be monitored for hemolysis after transfusion
  • Risk of hemolysis can be mitigated by using units that have low anti-A and anti-B titers (low titer O whole blood)
Transmission
  • WB may reduce the number of donor exposures and may reduce risk of transfusion transmitted infections
Screening
  • All blood for transfusion is tested for the presence of certain infectious disease pathogens
Blood donor screening
  • Armed Services Blood Program collects whole blood from male and never pregnant female donors or from female donors testing negative for anti-human leukocyte antigens antibodies (this mitigates risk of transfusion associated acute lung injury, transfusion related acute injury, and is an AABB / FDA requirement)
  • WB is collected from both Rh positive and negative donors (Mil Med 2018;183:44)
Blood donor selection
  • Donors are TRALI risk mitigated
  • Males and females who have never been pregnant
  • Rh positive and negative
Laboratory
  • Cold, stored whole blood may be stored at 1 - 6°C for up to 35 days (should be distinguished from fresh, warm whole blood)
Treatment
  • Used primarily in the treatment of trauma patients with massive bleeding
  • Protocols that use whole blood beyond day 21 should consider the need for supplemental platelet transfusion
Board review style question #1
How can the risk of hemolysis associated with the transfusion of group O whole blood to non group O recipients be mitigated?

  1. Agitating units in storage
  2. Leukoreduction
  3. Selecting units with low anti-A and anti-B titers
  4. Using units less than 7 days old
  5. Washing
Board review style answer #1
C. Selecting units with low anti-A and anti-B titers. The risk of hemolysis is due to the presence of anti-A and anti-B antibodies binding to recipient red cells. Selecting for low titers should minimize the risk. Washing would remove the plasma that is needed to provide coagulation factors that treat the trauma induced coagulopathy. Whole blood units can be leukoreduced but this does not impact hemolysis. Age of the units does not impact hemolysis. Whole blood is stored without agitation.

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