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Initial safety and feasibility of cold-stored uncrossmatched whole blood transfusion in civilian trauma patients

Yazer, Mark H. MD; Jackson, Byron MD; Sperry, Jason L. MD; Alarcon, Louis MD; Triulzi, Darrell J. MD; Murdock, Alan D. MD

Journal of Trauma and Acute Care Surgery: July 2016 - Volume 81 - Issue 1 - p 21–26
doi: 10.1097/TA.0000000000001100
EAST 2016 Plenary Papers
Editor's Choice

BACKGROUND The transfusion of cold-stored uncrossmatched whole blood (WB) has not been extensively used in civilian trauma resuscitation. This report details the initial experience with the safety and feasibility of using WB in this setting after a change of practice at a Level 1 trauma center was instituted.

METHODS Up to two units of uncrossmatched group O positive WB that was leukoreduced using a platelet-sparing filter from male donors were transfused to male trauma patients with hypotension secondary to bleeding. Hemolytic marker haptoglobin and reports of transfusion reactions in these patients were followed. Additionally, transfusion volumes and outcomes were compared to a historical cohort of male trauma patients who received at least one red blood cell (RBC) unit, but not WB, during the first 24 hours of admission.

RESULTS There were 47 WB patients who were transfused with a mean (SD) of 1.74 (0.61) WB units. The median haptoglobin concentration on post-WB transfusion Day 1 was 25.1 (9.3) mg/dL in 7 of 30 non–group O recipients. No adverse reactions in temporal relation to the WB transfusions were reported. There were 145 male historical control patients identified who were resuscitated with component therapy; the median volume of incompatible plasma transfused to the WB versus component therapy group was not significantly different (1,000 vs. 800 mL, respectively; p = 0.38); the mean plasma:RBC (0.99 [0.47] vs. 0.77 [ 0.73], respectively; p = 0.006) and platelet:RBC (0.72 [0.40] vs. 0.51 [0.734], respectively; p < 0.0001) ratios were significantly higher in the WB group.

CONCLUSION Transfusion of two units of cold-stored uncrossmatched WB is feasible and seems to be safe in civilian trauma resuscitation. Determining the efficacy of WB with regard to reducing the number of blood products transfused in the first 24 hours or improving recipient survival will require a larger randomized trial.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From The Institute for Transfusion Medicine (M.H.Y.,.D.J.T.), Pittsburgh, PA; Department of Pathology (M.H.Y., B.J., D.J.T.), University of Pittsburgh, Pittsburgh, PA; Department of Surgery (J.L.S., L.A., A.D.M.), University of Pittsburgh, Pittsburgh, PA; and Department of Surgery (A.D.M.), Allegheny General Hospital, Pittsburgh, PA.

Submitted: December 1, 2015, Revised: March 11, 2016, Accepted: March 25, 2016, Published online: April 27, 2016.

This study was presented at the 29th annual meeting of the Eastern Association for the Surgery of Trauma, January 12–16, 2016, in San Antonio, Texas.

Address for reprints: Alan D. Murdock, MD, FACS, Division of Trauma and General Surgery, Allegheny General Hospital, 5th Floor, South Tower, 320 E North Avenue, Pittsburgh, PA 15212; email: amurdock@wpahs.org.

© 2016 Lippincott Williams & Wilkins, Inc.