Anesthesia & Analgesia:
Letters to the Editor: Letters to the Editor
Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan Francisco, Californiamillerr@anesthesia.ucsf.edu
Dr. Spinella declined to respond.
To the Editor
Fresh whole blood (FWB) has been a component of transfusion therapy for over 70 years, often used as part of resuscitation management during military conflicts such as World War II.1 Accordingly, while the recent review of FWB by Spinella et al.2 was quite welcome and many of the current and obvious issues associated with the use of FWB were well described,2 they cited only a single United States Army document (reference 59) regarding transfusion medicine in Vietnam. However, there were also other military forces (e.g., Marines, Navy) conducting transfusion studies while in Vietnam, and most importantly, transfusion policy was not uniform among the military services. For example, Marines were generally resuscitated with crystalloid solutions in the field and transfused with blood only after arrival at the hospital, which was usually a short helicopter ride away.
On a personal level, my colleagues and I published several massive transfusion studies based on data collected while in Vietnam.3 When blood was administered, we usually transfused completely cross-matched blood. In urgent situations, we gave type-specific blood. I, my colleagues,4 and others5,6 specifically published data regarding the use of FWB in acutely wounded soldiers. We quantified the influence FWB had on clinical care and coagulation factors such as platelet counts in patients who received massive blood transfusions. Over 40 years later, this paper4 was featured as a classic paper in Anesthesiology,3 which allowed me to comment on the Vietnam experience and its ultimate importance in modern transfusion therapy.
As a further source of information, the 10th Annual Uniformed Services Society of Anesthesiologists meeting was held on October 12, 2012 in Washington, DC just before the American Society of Anesthesiologists’ Annual Meeting. Almost the entire day was devoted to transfusion therapy in all military branches, providing a comprehensive overview of military use of blood over the past 50 years. During that conference, the presenters acknowledged the magnitude of the Vietnam conflict with over 50,000 casualties and 300,000 wounded and its contribution to our knowledge of transfusion therapy. From a clinical perspective, I was impressed with their scholarly approach and analysis of the role for FWB in resuscitation and wish the article by Spinella et al.2 had included a broader perspective to take advantage of the broad experiences with administration of blood products to our military forces.
I thank my colleague, Dr. Neal Cohen, Vice Dean of Medicine, University of California San Francisco, for his editorial help.
Ronald D. Miller, MD, MS
Department of Anesthesia and Perioperative Care
University of California San Francisco
San Francisco, California
1. Hess JR. Blood use in war disaster: the U.S. experience. Scand J Trauma Resusc Emerg Med. 2005;13:74–8
2. Spinella PC, Reddy HL, Jaffe JS, Cap AP, Goodrich RP. Fresh whole blood use for hemorrhagic shock: preserving benefit while avoiding complications. Anesth Analg. 2012;115:751–8
3. Miller RD. Massive blood transfusions: the impact of Vietnam military data on modern civilian transfusion medicine. Anesthesiology. 2009;110:1412–6
4. Miller RD, Robbins TO, Tong MJ, Barton SL. Coagulation defects associated with massive blood transfusions. Ann Surg. 1971;174:794–801
5. Counts RB, Haisch C, Simon TL, Maxwell NG, Heimbach DM, Carrico CJ. Hemostasis in massively transfused trauma patients. Ann Surg. 1979;190:91–9
6. McNamara JJ, Burran EL, Stremple JF, Molot MD. Coagulopathy after major combat injury: occurrence, management, and pathophysiology. Ann Surg. 1972;176:243–6