The use of blood group O as "universal blood" for emergency whole blood transfusions carries the risk for a hemolytic transfusion reaction mediated by incompatible A/B antibodies. This risk can be ...minimized by assuring that the donor has a low titer of anti-A and anti-B. The level of these naturally occurring antibodies has been shown to be increased by vaccination with most biologically derived vaccines. This boostering effect has been investigated for the new generation of vaccines.
The 120 crew members of a Swedish naval ship deployed for 7 months to the Indian Ocean were tested for anti-A and anti-B before their predeployment vaccination program and after returning to Sweden. The vaccination program contained vaccines against cholera, diphtheria, hepatitis A and B, influenza, measles, meningitis, mumps, pertussis, polio, rubella, TBE virus, tetanus, typhus and yellow fever. Paired antibody titrations were performed for both IgM and IgG using microtube gelcards (Diamed GMBH).
No crew member, including the six belonging to the "high titer" group, showed a sign of a booster effect by any of the used vaccines.
The earlier reported boostering effects mediated by different vaccines cannot be replicated with the new vaccines of today. This is probably a result of the new manufacturing techniques resulting in much purer vaccines.
Therapeutic/care management study, level II.
Background
The increasing use of fresh blood group O whole blood in acute trauma medicine makes it important to reevaluate the issue of hemolytic reactions related to the transfusion of ...ABO‐incompatible plasma.
STUDY DESIGN AND METHODS
This review summarizes and evaluates published articles and case reports concerning hemolytic reactions in connection with the transfusion of group O whole blood or blood products to nongroup O recipients.
Results
In 1945‐1986, 15 nonmilitary publications reported hemolytic transfusion reactions with group O blood/blood products. All patients recovered except for two fatalities. Late in World War II and during the Korean and Vietnam wars and onward in Iraq and Afghanistan only “low anti‐A, anti‐B titer” group O whole blood has been used as universal blood. In spite of a large number of units transfused, there are no reports of hemolytic reactions. Twenty‐five publications report hemolytic reactions after transfusion of group O platelets to nongroup O recipients. In all patients but one, the titer of the implicated A‐ or B‐antibody was >100 (saline) or >400 (antiglobulin) and all cases with an infused volume of incompatible plasma <200 mL were related to anti‐A or anti‐B antiglobulin titers >1000.
Conclusion
In emergency lifesaving resuscitation, the risk of hemolytic transfusion reactions from transfusion of group O blood to nongroup O recipients constitutes risk that is outweighed by the benefits. A low titer of anti‐A/B will minimize the risk for a hemolytic reaction, particularly if the screening is repeated after an immunization episode, e.g., blood transfusion, vaccination, or pregnancy.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
ABSTRACTToward the end of World War I and during World War II, whole-blood transfusions were the primary agent in the treatment of military traumatic hemorrhage. However, after World War II, the ...fractionation of whole blood into its components became widely accepted and replaced whole-blood transfusion to better accommodate specific blood deficiencies, logistics, and financial reasons. This transition occurred with very few clinical trials to determine which patient populations or scenarios would or would not benefit from the change. A smaller population of patients with trauma hemorrhage will require massive transfusion (>10 U packed red blood cells in 24 h) occurring in 3% to 5% of civilian and 10% of military traumas. Advocates for hemostatic resuscitation have turned toward a ratio-balanced component therapy using packed red blood cells–fresh frozen plasma–platelet concentration in a 1:1:1 ratio due to whole-blood limited availability. However, this “reconstituted” whole blood is associated with a significantly anemic, thrombocytopenic, and coagulopathic product compared with whole blood. In addition, several recent military studies suggest a survival advantage of early use of whole blood, but the safety concerns have limited is widespread civilian use. Based on extensive military experience as well as recent published literature, low-titer leukocyte reduced cold-store type O whole blood carries low adverse risks and maintains its hemostatic properties for up to 21 days. A prospective randomized trial comparing whole blood versus ratio balanced component therapy is proposed with rationale provided.
ABSTRACTThe Trauma Hemostasis and Oxygenation Research Network held its third annual Remote Damage Control Resuscitation Symposium in June 2013 in Bergen, Norway. The Trauma Hemostasis and ...Oxygenation Research Network is a multidisciplinary group of investigators with a common interest in improving outcomes and safety in patients with severe traumatic injury. The network’s mission is to reduce the risk of morbidity and mortality from traumatic hemorrhagic shock, in the prehospital phase of resuscitation through research, education, and training. The concept of remote damage control resuscitation is in its infancy, and there is a significant amount of work that needs to be done to improve outcomes for patients with life-threatening bleeding secondary to injury. The prehospital phase of resuscitation is critical in these patients. If shock and coagulopathy can be rapidly identified and minimized before hospital admission, this will very likely reduce morbidity and mortality. This position statement begins to standardize the terms used, provides an acceptable range of therapeutic options, and identifies the major knowledge gaps in the field.
Abstract In most countries whole blood transfusions have been replaced by component therapy. This has allowed for both better usage of the blood donations and better quality during storage. While ...this strategy was initially motivated by the commercial need for plasma the plasma reduction also reduced the levels of low grade proteases and sialidase, hence minimizing the cellular storage lesion/microvesiculation during prolonged storage. Plasma reduction also reduces transfusion reactions associated with plasma. During special military conditions, however, blood transfusion is urgently needed without corresponding access to blood components, in particular platelets. Accordingly, new focus on whole blood has aroused and added a new challenge to the blood transfusion services. This special issue of “what is happening” highlights the planed efforts by Swedish and Norwegian groups in the developments of military walking blood bank, which is applicable to civil blood services.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background
In Afghanistan, a substantial portion of resuscitative combat surgery is performed by US Army forward surgical teams (FSTs). Red blood cells (RBCs) and fresh frozen plasma (FFP) are ...available at these facilities, but platelets are not. FST personnel frequently encounter high‐acuity patient scenarios without the ability to transfuse platelets. An analysis of the use of fresh whole blood (FWB) at FSTs therefore allows for an evaluation of outcomes associated with this practice.
Study Design and Methods
A retrospective analysis was performed in prospectively collected data from all transfused patients at six FSTs from December 2005 to December 2010. Univariate analysis was performed, followed by two separate propensity score analyses. In‐hospital mortality was predicted with the use of a conditional logistic regression model that incorporated these propensity scores. Subset analysis included evaluation of patients who received uncrossmatched Type O FWB compared with those who received type‐specific FWB.
Results
A total of 488 patients received a blood transfusion. There were no significant differences in age, sex, or Glasgow Coma Scale in those who received or did not receive FWB. Injury Severity Scores were higher in patients transfused FWB. In our adjusted analyses, patients who received RBCs and FFP with FWB had improved survival compared with those who received RBCs and FFP without FWB. Of 94 FWB recipients, 46 FWB recipients (49%) were given uncrossmatched Type O FWB, while 48 recipients (51%) received type‐specific FWB. There was no significant difference in mortality between patients that received uncrossmatched Type O and type‐specific FWB.
Conclusions
The use of FWB in austere combat environments appears to be safe and is independently associated with improved survival to discharge when compared with resuscitation with RBCs and FFP alone. Mortality was similar for patients transfused uncrossmatched Type O compared with ABO type‐specific FWB in an austere setting.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
ABSTRACTIn past and ongoing military conflicts, the use of whole blood (WB) as a resuscitative product to treat trauma-induced shock and coagulopathy has been widely accepted as an alternative when ...availability of a balanced component-based transfusion strategy is restricted or lacking. In previous military conflicts, ABO group O blood from donors with low titers of anti-A/B blood group antibodies was favored. Now, several policies demand the exclusive use of ABO group–specific WB. In this short review, we argue that the overall risks, dangers, and consequences of “the ABO group–specific approach,” in emergencies, make the use of universal group O WB from donors with low titers of anti-A/B safer. Generally, risks with ABO group–specific transfusions are associated with in vivo destruction of the red blood cells transfused. The risk with group O WB is from the plasma transfused to ABO-incompatible patients. In the civilian setting, the risk of clinical hemolytic transfusion reactions (HTRs) due to ABO group–specific red blood cell transfusions is relatively low (approximately 1:80,000), but the consequences are frequently severe. Civilian risk of HTRs due to plasma incompatible transfusions, using titered donors, is approximately 1:120,000 but usually of mild to moderate severity. Emergency settings are often chaotic and resource limited, factors well known to increase the potential for human errors. Using ABO group–specific WB in emergencies may delay treatment because of needed ABO typing, increase the risk of clinical HTRs, and increase the severity of these reactions as well as increase the danger of underresuscitation due to lack of some ABO groups. When the clinical decision has been made to transfuse WB in patients with life-threatening hemorrhagic shock, we recommend the use of group O WB from donors with low anti-A/B titers when logistical constraints preclude the rapid availability of ABO group–specific WB and reliable group matching between donor and recipient is not feasible.
Background
In
A
fghanistan, a substantial portion of resuscitative combat surgery is performed by
US A
rmy forward surgical teams (
FST
s). Red blood cells (
RBC
s) and fresh frozen plasma (
FFP
) ...are available at these facilities, but platelets are not.
FST
personnel frequently encounter high‐acuity patient scenarios without the ability to transfuse platelets. An analysis of the use of fresh whole blood (
FWB
) at
FST
s therefore allows for an evaluation of outcomes associated with this practice.
Study Design and Methods
A retrospective analysis was performed in prospectively collected data from all transfused patients at six
FST
s from
D
ecember 2005 to
D
ecember 2010. Univariate analysis was performed, followed by two separate propensity score analyses. In‐hospital mortality was predicted with the use of a conditional logistic regression model that incorporated these propensity scores. Subset analysis included evaluation of patients who received uncrossmatched
T
ype
O FWB
compared with those who received type‐specific
FWB
.
Results
A total of 488 patients received a blood transfusion. There were no significant differences in age, sex, or
G
lasgow
C
oma
S
cale in those who received or did not receive
FWB
.
I
njury
S
everity
S
cores were higher in patients transfused
FWB
. In our adjusted analyses, patients who received
RBC
s and
FFP
with
FWB
had improved survival compared with those who received
RBC
s and
FFP
without
FWB
. Of 94
FWB
recipients, 46
FWB
recipients (49%) were given uncrossmatched
T
ype
O FWB
, while 48 recipients (51%) received type‐specific
FWB
. There was no significant difference in mortality between patients that received uncrossmatched
T
ype
O
and type‐specific
FWB
.
Conclusions
The use of
FWB
in austere combat environments appears to be safe and is independently associated with improved survival to discharge when compared with resuscitation with
RBC
s and
FFP
alone. Mortality was similar for patients transfused uncrossmatched
T
ype
O
compared with
ABO
type‐specific
FWB
in an austere setting.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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