I thank Drs. Pitkin and Rice for their interest in my editorial, “Reconstructing Deconstructed Blood for Trauma,”1
and the issue of the utility of whole blood. Although my editorial focused on trauma, I agree with Drs. Pitkin and Rice that the potential for the appropriate utilization of whole blood applies to other clinical circumstances of substantial blood volume replacement, as well.
When citing the limited supportive clinical trial literature,2
I was careful to indicate that those studies addressed adults. I did not cite the study performed in pediatric cardiac surgery patients4
because it was not fully blinded and only partially randomized, thus making interpretation of the results quite problematic. In addition, the analysis in that publication of a subpopulation (whose removal from the overall analysis reduced the results to statistical nonsignificance in the remaining population: those younger than 2 yr with surgery of lesser difficulty, and all those studied who were older than 2 yr) appears to have been post hoc
, thus providing an interesting hypothesis, but not proof.
As I wrote,1
determination of platelet efficacy is not straightforward and requires careful analysis of source, and storage conditions (time, temperature, and medium), as well as the timing and method of assessment. Platelet quantity and quality are critical components of coagulation, making transfusion of viable, functional platelets an important consideration for the use of whole blood.
Whole blood has potential indications other than that of trauma, although current studies and greatest interest are focused on trauma. The U.S. military continues to use whole blood for some combat injuries, but the road to the return for its use in civilian practice will require a concerted effort by interested clinicians, such as Drs. Pitkin and Rice.
Richard B. Weiskopf, M.D., University of California, San Francisco, San Francisco, California. firstname.lastname@example.org
1. Weiskopf RB: Reconstructing deconstructed blood for trauma. ANESTHESIOLOGY 2012; 116:518–21
2. Triulzi DJ, Gilmor GD, Ness PM, Baumgartner WA, Schultheis LW: Efficacy of autologous fresh whole blood or platelet-rich plasma in adult cardiac surgery. Transfusion 1995; 35:627–34
3. Mohr R, Martinowitz U, Lavee J, Amroch D, Ramot B, Goor DA: The hemostatic effect of transfusing fresh whole blood versus platelet concentrates after cardiac operations. J Thorac Cardiovasc Surg 1988; 96:530–4
4. Manno CS, Hedberg KW, Kim HC, Bunin GR, Nicolson S, Jobes D, Schwartz E, Norwood WI: Comparison of the hemostatic effects of fresh whole blood, stored whole blood, and components after open heart surgery in children. Blood 1991; 77:930–6
© 2012 American Society of Anesthesiologists, Inc.