☆ 4.5 Review

Use of Low-Titer O-Positive Whole Blood in Female Trauma Patients: A Literature Review, Qualitative Multidisciplinary Analysis of Risk/Benefit, and Guidelines for Its Use as a Universal Product in Hemorrhagic Shock

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS (2024)

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Article Surgery

Low Titer Group O Whole Blood In Injured Children Requiring Massive Transfusion

Barbara A. A. Gaines et al.

Summary: The study aimed to assess the survival impact of low-titer group O whole blood (LTOWB) in injured pediatric patients who require massive transfusion. The results showed that the use of LTOWB significantly improved the 72-hour and 28-day survival rates of pediatric patients, and the survivors in the LTOWB group had reduced hospital LOS, ICU LOS, and ventilator days.

ANNALS OF SURGERY (2023)

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Review Critical Care Medicine

Resuscitative practices and the use of low-titer group O whole blood in pediatric trauma

Katrina M. Morgan et al.

Summary: The increasing rates of penetrating trauma in the United States emphasize the importance of rapidly identifying hemorrhagic shock and coagulopathy in injured children. Early initiation of balanced resuscitation is vital to improve outcomes. Recent data support the use of blood products instead of crystalloid for resuscitation, as crystalloid has been associated with worse coagulopathy and clinical outcomes. Multicenter studies have shown improved survival in injured children who receive balanced resuscitation with higher fresh frozen plasma: red blood cell ratios. Whole blood, particularly cold-stored, low-titer O-negative whole blood, may be a safe and efficient option for resuscitation in critically injured children with limited intravenous access. However, there is a scarcity of such blood products compared to the demand, and the risks of hemolytic disease in future pregnancies must be considered. Further research is needed to establish optimal resuscitation practices in injured children, particularly in the era of increasing penetrating trauma.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2023)

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Article Critical Care Medicine

The females have spoken: A patient-centered national survey on the administration of emergent transfusions with the potential for future fetal harm

Rindi Uhlich et al.

Summary: This national survey found that most females are willing to accept blood transfusion even with the potential low risk of future fetal harm.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2023)

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Article Critical Care Medicine

The reports of my death are greatly exaggerated: An evaluation of futility cut points in massive transfusion

Thomas W. Clements et al.

Summary: This study found that the survival rate for trauma patients who received over 50 U of blood within the first 4 hours is as high as 50% to 60%, with a 43% increased odds of survival if they received whole blood compared to component therapy. High transfusion volumes alone should not be used as a determinant of futility in patient treatment.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2023)

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Review Critical Care Medicine

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Robert A. van der Horst et al.

Summary: This meta-analysis study found that whole blood transfusion is more effective than blood component transfusion in improving the survival rate of trauma patients with acute hemorrhage. Additionally, whole blood transfusion can increase the ratios of platelet/red blood cell and plasma/red blood cell. Rating: 8/10.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2023)

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Article Hematology

Emergency transfusion with whole blood versus packed red blood cells: A study of 1400 patients

Kristen N. N. Ruby et al.

Summary: This study compared the initial use of low-titer group O whole blood (LTOWB) with packed red blood cells (pRBCs) for emergency transfusion. The results showed that patients receiving LTOWB had significantly increased blood product use at 24 hours and 7 days, but there was no improvement in 30-day survival or reduction in non-lethal adverse clinical outcomes.

TRANSFUSION (2023)

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Review Hematology

Mortality and outcomes by blood group in trauma patients: A systematic review and meta-analysis

David T. Lubkin et al.

Summary: This article reviews the relationship between blood type and outcomes in trauma patients and finds inconsistent results. However, overall, patients with blood type O have a higher risk of bleeding, transfusion requirement, and mortality.

VOX SANGUINIS (2023)

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Review Surgery

Outcomes of Transfusion With Whole Blood, Component Therapy, or Both in Adult Civilian Trauma Patients: A Systematic Review and Meta-Analysis

Micah Ngatuvai et al.

Summary: This systematic review and meta-analysis compared outcomes for adult civilian trauma patients transfused with whole blood (WB), components (COMP), or both (WB + COMP). The study found that WB + COMP was associated with lower 24-h mortality compared to COMP, and WB was associated with a lower volume of red blood cells transfused at both 6 and 24 h compared to COMP. There were no differences in infection rates or intensive care unit length of stay between WB and COMP.

JOURNAL OF SURGICAL RESEARCH (2023)

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Article Surgery

Whole Blood Versus Conventional Blood Component Massive Transfusion Protocol Therapy in Civilian Trauma Patients

Janet S. Lee et al.

Summary: This study compared the use of LTOWB and BCT massive transfusion protocols in civilian trauma patients, finding a lower in-hospital mortality rate in the LTOWB group, with no significant differences in transfusion volumes and complications. Multivariable logistic regression identified Injury Severity Score, age, and 24-hour transfusion volume as predictors of mortality.

AMERICAN SURGEON (2022)

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Article Critical Care Medicine

Prehospital low titer group O whole blood is feasible and safe: Results of a prospective randomized pilot trial

Frank X. Guyette et al.

Summary: Prehospital through in-hospital LTOWB resuscitation is safe and may provide hemostatic benefits.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2022)

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Article Hematology

Estimating the risks of prehospital transfusion of D-positive whole blood to trauma patients who are bleeding in England

Rebecca Cardigan et al.

Summary: The risk of transfusing RhD-positive blood is low in the prehospital setting and must be balanced against its potential benefits.

VOX SANGUINIS (2022)

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Article Obstetrics & Gynecology

Whole blood transfusion reduces overall component transfusion in cases of placenta accreta spectrum: a pilot program

Jessian L. Munoz et al.

Summary: This study analyzed the treatment of 34 patients with placenta accreta spectrum (PAS) and found that initial resuscitation with whole blood can reduce transfusion volume and resuscitation volume, without directly affecting post-operative outcomes.

JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE (2022)

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Article Surgery

Whole blood at the tip of the spear: A retrospective cohort analysis of warm fresh whole blood resuscitation versus component therapy in severely injured combat casualties

Jennifer M. Gurney et al.

Summary: This study compared the early mortality rates of patients who received warm fresh whole blood with those who did not. The results showed a significant reduction in 6-hour mortality among the warm fresh whole blood group, with a dose-dependent effect. These findings support the use of warm fresh whole blood for hemorrhage control and call for further research in military and civilian trauma settings.

SURGERY (2022)

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Article Surgery

Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding A Multicenter Study

Joshua P. Hazelton et al.

Summary: This study aimed to investigate the use of whole blood in the resuscitation of bleeding trauma patients. The results showed that compared to blood component therapy, the use of whole blood was associated with a reduction in mortality and bleeding complications.

ANNALS OF SURGERY (2022)

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Article Hematology

The regional whole blood program in San Antonio, TX: A 3-year update on prehospital and in-hospital transfusion practices for traumatic and non-traumatic hemorrhage

Maxwell A. Braverman et al.

Summary: LTO + WB has become a first-line resuscitation medium for hemorrhagic shock and has been widely used in many centers worldwide. The system has expanded to include various special populations such as children, women of childbearing potential, and non-traumatic hemorrhage. This manuscript provides a three-year update on the successes and expansion of the system, as well as outlines resuscitation challenges in special populations.

TRANSFUSION (2022)

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Article Surgery

National analysis of whole blood and component versus component transfusions in civilian trauma patients who underwent a thoracotomy or laparotomy: Toward improving patient outcomes and quality of care

Ryan Andrade et al.

Summary: This study investigated the associations between whole blood and component versus component transfusions in adult civilian trauma patients and found that a combined resuscitation with whole blood and component transfusion is a viable alternative to component transfusion in these patients.

SURGERY (2022)

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Article Critical Care Medicine

The prehospital use of younger age whole blood is associated with an improved arrival coagulation profile

Thomas Clements et al.

Summary: The study suggests that receiving younger whole blood in prehospital setting may improve coagulation, but did not lead to increased transfusion requirements. Further research is needed to determine the optimal storage duration for cold-stored whole blood for transfusion in trauma patients.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2021)

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Review Medicine, General & Internal

Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review

Mark Walsh et al.

Summary: This review examines the pathophysiology, geographic variation, and historical developments of fixed ratio versus whole blood resuscitation for hemorrhaging trauma patients. It introduces a physiologically driven and goal-directed alternative to guide blood component and factor concentrate administration to severely bleeding trauma patients, with a focus on major studies and upcoming comparative trials.

JOURNAL OF CLINICAL MEDICINE (2021)

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Article Hematology

Injured recipients of low-titer group O whole blood have similar clinical outcomes compared to recipients of conventional component therapy: A single-center, retrospective study

Mark H. Yazer et al.

Summary: This study compared clinical outcomes between trauma patients receiving LTOWB and conventional component therapy (CCT), and found no significant differences in major clinical outcomes between the two groups.

TRANSFUSION (2021)

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Article Obstetrics & Gynecology

Management and clinical consequences of red blood cell antibodies in pregnancy: A population-based cohort study

Shengxin Liu et al.

Summary: This study analyzed all alloimmunized singleton pregnancies in the Stockholm region from 1990 to 2016, finding that 46% of pregnancies carried anti-D antibodies, 15% carried anti-E antibodies, and 12% carried anti-c antibodies. The highest risk for intrauterine blood transfusion was observed in pregnancies affected by anti-D antibodies in combination with other antibodies.

ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA (2021)

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Article Critical Care Medicine

Can RH plus whole blood be safely used as an alternative to RH- product? An analysis of efforts to improve the sustainability of a hospital's low titer group O whole blood program

C. Cameron McCoy et al.

Summary: The study found that when Rh- whole blood is unavailable, Rh+ LTO-WB can safely substitute for Rh- products, regardless of patient's Rh status. There were no significant differences in hemolysis laboratories, transfusion reactions, complications, or survival between patients receiving Rh+ and Rh- products.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2021)

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Article Critical Care Medicine

A pilot study of stored low titer group O whole blood plus component therapy versus component therapy only for civilian trauma patients

Anaar E. Siletz et al.

Summary: This study found that starting resuscitation with LTOWB resulted in similar outcomes compared to resuscitation with CT only, in terms of transfusion requirements and treatment outcomes.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2021)

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Article Critical Care Medicine

Whole blood hemostatic resuscitation in pediatric trauma: A nationwide propensity-matched analysis

Tanya Anand et al.

Summary: The study found that using whole blood as an adjunct to component therapy can decrease transfusion requirements and ventilation days in pediatric trauma patients, with no significant impact on mortality rate, hospital length of stay, and major complications.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2021)

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Article Hematology

Prehospital whole blood reduces early mortality in patients with hemorrhagic shock

Maxwell A. Braverman et al.

Summary: This study showed that trauma patients who received prehospital LTOWB transfusion had a greater improvement in SI and a reduction in early mortality, but patients with prehospital cardiac arrest did not experience improved survival. These findings support the use of LTOWB in the prehospital setting, however, further prospective studies are needed to confirm these results.

TRANSFUSION (2021)

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Article Hematology

Rate of RhD-alloimmunization after the transfusion of multiple RhD-positive primary red blood cell-containing products

Mark H. Yazer et al.

Summary: Early transfusion of RhD-positive blood products does not increase the risk of RhD-alloimmunization. Also, the speed of receiving RhD-positive transfusions may impact the immunization rate.

TRANSFUSION (2021)

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Article Critical Care Medicine

Back to the Future: Whole Blood Resuscitation of the Severely Injured Trauma Patient

Christopher Cameron McCoy et al.

Summary: Whole blood transfusion played a significant role in treating casualties in past wars, but civilian centers have transitioned to blood component therapies. Recent studies suggest that whole blood transfusion may be more effective for treating trauma patients.

SHOCK (2021)

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Article Critical Care Medicine

Safety profile and impact of low-titer group O whole blood for emergency use in trauma

James Williams et al.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2020)

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Review Genetics & Heredity

Red cell alloimmunization: A 2020 update

James S. Castleman et al.

PRENATAL DIAGNOSIS (2020)

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Article Critical Care Medicine

Large volume transfusion with whole blood is safe compared with component therapy

Jared Robert Gallaher et al.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2020)

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Article Critical Care Medicine

Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma

Kamil Hanna et al.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2020)

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Review Critical Care Medicine

Fresh whole blood from walking blood banks for patients with traumatic hemorrhagic shock: A systematic review and meta-analysis

David N. Naumann et al.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2020)

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Article Hematology

Improved survival in critically injured combat casualties treated with fresh whole blood by forward surgical teams in Afghanistan

Jennifer Gurney et al.

TRANSFUSION (2020)

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Article Hematology

Whole blood for postpartum hemorrhage: early experience at two institutions

David S. Morris et al.

TRANSFUSION (2020)

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Article Hematology

Impact of red blood cell alloimmunization on fetal and neonatal outcomes: A single center cohort study

Lani Lieberman et al.

TRANSFUSION (2020)

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Article Hematology

It is time to reconsider the risks of transfusing RhD negative females of childbearing potential with RhD positive red blood cells in bleeding emergencies

Mark H. Yazer et al.

TRANSFUSION (2019)

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Perceived burden in dealing with different rare diseases: a qualitative focus group study

Natalie Uhlenbusch et al.

BMJ OPEN (2019)

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Review Anesthesiology

Whole Blood for Resuscitation in Adult Civilian Trauma in 2017: A Narrative Review

Evan G. Pivalizza et al.

ANESTHESIA AND ANALGESIA (2018)

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Article Critical Care Medicine

Prehospital low-titer cold-stored whole blood: Philosophy for ubiquitous utilization of O-positive product for emergency use in hemorrhage due to injury

Ashley C. McGinity et al.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2018)

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Article Obstetrics & Gynecology

Management of Alloimmunization During Pregnancy

Calla Holmgren et al.

OBSTETRICS AND GYNECOLOGY (2018)

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Article Hematology

Maternal red blood cell alloimmunization requiring intrauterine transfusion: a comparative study on management and outcome depending on the type of antibody

Thanh-Vy Phung et al.

TRANSFUSION (2018)

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Article Hematology

Safety profile of uncrossmatched, cold-stored, low-titer, group O plus whole blood in civilian trauma patients

Jansen N. Seheult et al.

TRANSFUSION (2018)

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Article Critical Care Medicine

Prehospital low-titer cold-stored whole blood: Philosophy for ubiquitous utilization of O-positive product for emergency use in hemorrhage due to injury

Ashley C. McGinity et al.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2018)

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Article Surgery

Balanced Resuscitation in Trauma Management

Paul M. Cantle et al.

SURGICAL CLINICS OF NORTH AMERICA (2017)

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Article Acoustics

Complications of intrauterine intravascular blood transfusion: lessons learned after 1678 procedures

C. Zwiers et al.

ULTRASOUND IN OBSTETRICS & GYNECOLOGY (2017)

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Review Hematology

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn - review on current management and outcome

Carolien Zwiers et al.

EXPERT REVIEW OF HEMATOLOGY (2017)

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Article Hematology

Emergency transfusion of patients with unknown blood type with blood group O Rhesus D positive red blood cell concentrates: a prospective, single-centre, observational study

Kathleen Selleng et al.

LANCET HAEMATOLOGY (2017)

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

Mark H. Yazer et al.

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

Mark H. Yazer et al.

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Hemolytic disease of the fetus and newborn due to multiple maternal antibodies

Kara Beth Markham et al.

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY (2015)

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Coagulation function of stored whole blood is preserved for 14 days in austere conditions: A ROTEM feasibility study during a Norwegian antipiracy mission and comparison to equal ratio reconstituted blood

Geir Strandenes et al.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2015)

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The safety of early fresh, whole blood transfusion among severely battle injured at US Marine Corps forward surgical care facilities in Afghanistan

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TRAUMA, TIME, AND TRANSFUSIONS: A LONGITUDINAL ANALYSIS OF COAGULATION MARKERS IN SEVERELY INJURED TRAUMA PATIENTS RECEIVING MODIFIED WHOLE BLOOD OR COMPONENT BLOOD PRODUCTS

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Coagulation function of stored whole blood is preserved for 14 days in austere conditions: A ROTEM feasibility study during a Norwegian antipiracy mission and comparison to equal ratio reconstituted blood

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JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2015)

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The safety of early fresh, whole blood transfusion among severely battle injured at US Marine Corps forward surgical care facilities in Afghanistan

Jonathan D. Auten et al.

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY (2015)

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Article Critical Care Medicine

Increased Mortality in Adult Patients With Trauma Transfused With Blood Components Compared With Whole Blood

Allison R. Jones et al.

JOURNAL OF TRAUMA NURSING (2014)

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Article Surgery

A Randomized Controlled Pilot Trial of Modified Whole Blood versus Component Therapy in Severely Injured Patients Requiring Large Volume Transfusions

Bryan A. Cotton et al.

ANNALS OF SURGERY (2013)

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Article Hematology

Lack of effect of unrefrigerated young whole blood transfusion on patient outcomes after massive transfusion in a civilian setting

Kwok M. Ho et al.

TRANSFUSION (2011)

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Article Hematology

Comparison of platelet transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients (CME)

Jeremy G. Perkins et al.

TRANSFUSION (2011)

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Prospective evaluation of a transfusion policy of D+ red blood cells into D- patients

Jose R. Gonzalez-Porras et al.

TRANSFUSION (2008)

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Prevention of D sensitization after mismatched transfusion of blood components: toward optimal use of RhIG

Saleh Ayache et al.

TRANSFUSION (2008)

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Article Hematology

Detection of anti-D in D- recipients transfused with D+ red blood cells

Mark H. Yazer et al.

TRANSFUSION (2007)

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Transfusion-associated microchimerism: A new complication of blood transfusions in severely injured patients

William Reed et al.

SEMINARS IN HEMATOLOGY (2007)

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Article Hematology

Anti-D alloimmunization after D-mismatched allogeneic hematopoietic stem cell transplantation in patients with hematologic diseases

J Cid et al.

TRANSFUSION (2006)

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Article Hematology

Prevention of immunization to D+ red blood cells with red blood cell exchange and intravenous Rh immune globulin

TA Nester et al.

TRANSFUSION (2004)

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Article Hematology

Probability of anti-D development in D- patients receiving D+ RBCs

C Frohn et al.

TRANSFUSION (2003)

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Article Hematology

Absence of anti-D alloimmunization in hematologic patients after D-incompatible platelet transfusions

J Cid et al.

TRANSFUSION (2002)

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