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The Armed Services Blood Program: Blood support to combat casualty care 2001 to 2011

Rentas, Francisco PhD; Lincoln, David; Harding, Aaron; Maas, Peter; Giglio, Joseph; Fryar, Ronny; Elder, Kathleen; Fahie, Roland; Whitlock, Kathleen; Vinluan, Jerome; Gonzales, Richard

Journal of Trauma and Acute Care Surgery: December 2012 - Volume 73 - Issue 6 - p S472–S478
doi: 10.1097/TA.0b013e31827546e4
Original Articles

BACKGROUND The Armed Services Blood Program (ASBP) provides the farthest-reaching blood supply in the world. This article provides statistics and a review of blood operations in support of combat casualty care during the last 10 years. It also outlines changes in blood doctrine in support of combat casualty care.

METHODS This is a descriptive overview and review of blood product use and transfusions used by ASBP personnel to support combat operations in Iraq and Afghanistan between October 2001 and November 2011.

RESULTS The ASBP initiated major changes in blood availability and age of blood in theater. In support of data published by physicians in theater, showing improved patient survival when a higher ratio of fresh frozen plasma and red blood cells (RBCs) is achieved, plus the use of platelets, the ASBP increased availability of plasma and established platelet collection facilities in theater. New capabilities included emergency collection of apheresis platelets in the battlefield, availability and transfusion of deglycerolized red cells, rapid diagnostic donor screening, and a new modular blood detachment. Forward surgical facilities that were at one time limited to a blood inventory consisting of RBCs now have a complete arsenal of products at their fingertips that may include fresher RBCs, fresh frozen plasma, cryoprecipitate, and platelets. A number of clinical practice guidelines are in place to address these processes. Changes in blood doctrine were made to support new combat casualty care and damage-control resuscitation initiatives.

CONCLUSION Despite the challenges of war in two theaters of operation, a number of improvements and changes to blood policy have been developed during the last 10 years to support combat casualty care. The nature of medical care in combat operations will continue to be dynamic and constantly evolving. The ASBP needs to be prepared to meet future challenges.

LEVEL OF EVIDENCE Epidemiologic study, level IV.

From the Armed Services Blood Program Office (F.R., D.L., A.H., P.M.), Falls Church, Virginia; Army Blood Program (R.Fr., K.E.), Falls Church, Virginia; Navy Blood Program (R.Fa., K.W.), Washington, District of Columbia; Armed Services Whole Blood Processing Laboratory (J.V.), McGuire Air Force Base, New Jersey; US Army Medical Material Development Activity (R.G.), Fort Detrick, Maryland.

The views and opinions expressed in this article are those of the authors and do not reflect the official policy or position of the Army Medical Department, Department of the Army, Department of the Navy, Department of the Air Force, the Department of Defense, or the US Government.

Address for reprints: Francisco J. Rentas, PhD, Armed Services Blood Program Office, 5109 Leesburg Pike, Suite 698, Falls Church, VA 22041; email:

© 2012 Lippincott Williams & Wilkins, Inc.