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Malone JR. Ethical considerations in the use of RhD-positive blood products in trauma. Transfusion 2024; 64 Suppl 2:S4-S10. [PMID: 38491917 DOI: 10.1111/trf.17787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Prehospital and early in-hospital use of low titer group O whole blood (LTOWB) for life-threatening bleeding has been independently associated with improved survival compared to component therapy. However, when RhD-positive blood products are administered to RhD-negative females of childbearing potential (FCP), there is a small future risk of hemolytic disease of the fetus and newborn (HDFN). This raises important ethical questions that must be explored in order to justify the use of RhD-positive blood products, including LTOWB, both in clinical practice and research. METHODS This essay explores the ethical challenges related to RhD-positive blood product administration to RhD-negative or RhD-unknown FCPs as a first-line resuscitation fluid in the trauma setting. These ethical issues include: issues related to decision-making, ethical analysis based on the doctrine of double effect (DDE), and attendant obligations incurred by hospitals that administer RhD-positive blood to FCPs. RESULTS Ethical analysis through the use of the DDE demonstrates that utilization of RhD-positive blood products, including LTOWB, in the early resuscitation of FCPs is an ethically appropriate approach. By accepting the risk of HDFN, hospitals generate obligations to promote blood donation, evaluate for alloimmunization and counsel patients on the future risk of HDFN, and maintain an understanding of the ethical rationale for RhD-positive blood transfusion.
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Affiliation(s)
- Jay R Malone
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Susila S, Ilmakunnas M, Lauronen J, Vuorinen P, Ångerman S, Sainio S. Low titer group O whole blood and risk of RhD alloimmunization: Rationale for use in Finland. Transfusion 2024; 64 Suppl 2:S119-S125. [PMID: 38240146 DOI: 10.1111/trf.17700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Prehospital low-titer group O whole blood (LTOWB) used for patients with life-threatening hemorrhage is often RhD positive. The most important complication following RhD alloimmunization is hemolytic disease of the fetus and newborn (HDFN). Preceding clinical use of RhD positive LTOWB, we estimated the risk of HDFN due to LTOWB prehospital transfusion in the Finnish population. STUDY DESIGN AND METHODS We collected data on prehospital transfusions in Tampere and Helsinki University Hospital areas. Using the mean of reported alloimmunization rates in trauma studies (24%) and a higher reported rate representing trauma patients of 13-50 years old (42.7%), we estimated the risk of HDFN and extrapolated it to the whole of Finland. RESULTS We estimated that in Finland, with the current prehospital transfusion rate we would see 1-3 cases of severe HDFN due to prehospital LTOWB transfusions every 10 years, and fetal death due to HDFN caused by LTOWB transfusion less than once in 100 years. DISCUSSION The estimated risk of serious HDFN due to prehospital LTOWB transfusion in the Finnish population is similar to previous estimates. As Finland routinely screens expectant mothers for red blood cell antibodies and as the contemporary treatment of HDFN is very effective, we support the prehospital use of RhD positive LTOWB in all patient groups.
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Affiliation(s)
- Sanna Susila
- Finnish Red Cross Blood Service, Vantaa, Finland
- Emergency Medical Service and Emergency Department, Päijät-Häme wellbeing services county, Lahti, Finland
| | - Minna Ilmakunnas
- Finnish Red Cross Blood Service, Vantaa, Finland
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Pauli Vuorinen
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa wellbeing services county, Tampere, Finland
| | - Susanne Ångerman
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Clements TW, Van Gent JM, Menon N, Roberts A, Sherwood M, Osborn L, Hartwell B, Refuerzo J, Bai Y, Cotton BA. 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. J Am Coll Surg 2024; 238:347-357. [PMID: 37930900 DOI: 10.1097/xcs.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Whole blood transfusion is associated with benefits including improved survival, coagulopathy, and decreased transfusion requirements. The majority of whole blood transfusion is in the form of low-titer O-positive whole blood (LTOWB). Practice at many trauma centers withholds the use of LTOWB in women of childbearing potential due to concerns of alloimmunization. The purpose of this article is to review the evidence for LTOWB transfusion in female trauma patients and generate guidelines for its application. STUDY DESIGN Literature and evidence for LTOWB transfusion in hemorrhagic shock are reviewed. The rates of alloimmunization and subsequent obstetrical outcomes are compared to the reported outcomes of LTOWB vs other resuscitation media. Literature regarding patient experiences and preferences in regards to the risk of alloimmunization is compared to current trauma practices. RESULTS LTOWB has shown improved outcomes in both military and civilian settings. The overall risk of alloimmunization for Rhesus factor (Rh) - female patients in hemorrhagic shock exposed to Rh + blood is low (3% to 20%). Fetal outcomes in Rh-sensitized patients are excellent compared to historical standards, and treatment options continue to expand. The majority of female patients surveyed on the risk of alloimmunization favor receiving Rh + blood products to improve trauma outcomes. Obstetrical transfusion practices have incorporated LTOWB with excellent results. CONCLUSIONS The use of whole blood resuscitation in trauma is associated with benefits in the resuscitation of severely injured patients. The rate at which severely injured, Rh-negative patients develop anti-D antibodies is low. Treatments for alloimmunized pregnancies have advanced, with excellent results. Fears of alloimmunization in female patients are likely overstated and may not warrant the withholding of whole blood resuscitation. The benefits of whole blood resuscitation likely outweigh the risks of alloimmunization.
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Affiliation(s)
- Thomas W Clements
- From the Departments of Surgery (Clements, Van Gent, Cotton), McGovern Medical School, Houston, Texas
| | - Jan-Michael Van Gent
- From the Departments of Surgery (Clements, Van Gent, Cotton), McGovern Medical School, Houston, Texas
| | - Neethu Menon
- Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School (Menon, Roberts, Refuerzo), McGovern Medical School, Houston, Texas
| | - Aaron Roberts
- Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School (Menon, Roberts, Refuerzo), McGovern Medical School, Houston, Texas
| | | | - Lesley Osborn
- Emergency Medicine (Osborn), McGovern Medical School, Houston, Texas
| | - Beth Hartwell
- Gulf Coast Regional Blood Center, Houston, Texas (Hartwell)
| | - Jerrie Refuerzo
- Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School (Menon, Roberts, Refuerzo), McGovern Medical School, Houston, Texas
| | - Yu Bai
- Pathology and Laboratory Medicine (Bai), McGovern Medical School, Houston, Texas
| | - Bryan A Cotton
- From the Departments of Surgery (Clements, Van Gent, Cotton), McGovern Medical School, Houston, Texas
- Center for Translational Injury Research, Houston, Texas (Cotton)
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Maier CL, Brohi K, Curry N, Juffermans NP, Mora Miquel L, Neal MD, Shaz BH, Vlaar APJ, Helms J. Contemporary management of major haemorrhage in critical care. Intensive Care Med 2024; 50:319-331. [PMID: 38189930 DOI: 10.1007/s00134-023-07303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024]
Abstract
Haemorrhagic shock is frequent in critical care settings and responsible for a high mortality rate due to multiple organ dysfunction and coagulopathy. The management of critically ill patients with bleeding and shock is complex, and treatment of these patients must be rapid and definitive. The administration of large volumes of blood components leads to major physiological alterations which must be mitigated during and after bleeding. Early recognition of bleeding and coagulopathy, understanding the underlying pathophysiology related to specific disease states, and the development of individualised management protocols are important for optimal outcomes. This review describes the contemporary understanding of the pathophysiology of various types of coagulopathic bleeding; the diagnosis and management of critically ill bleeding patients, including major haemorrhage protocols and post-transfusion management; and finally highlights recent areas of opportunity to better understand optimal management strategies for managing bleeding in the intensive care unit (ICU).
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Affiliation(s)
- Cheryl L Maier
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, USA
| | - Karim Brohi
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Nicola Curry
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Clinical and Laboratory Sciences, Radcliffe Department of Medicine, Oxford University, Oxford, UK
| | - Nicole P Juffermans
- Department of Intensive Care and Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lidia Mora Miquel
- Department of Anaesthesiology, Intensive Care and Pain Clinic, Vall d'Hebron Trauma, Rehabilitation and Burns Hospital, Autonomous University of Barcelona, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Matthew D Neal
- Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth H Shaz
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | | | - Julie Helms
- Service de Médecine Intensive-Réanimation, Department of Intensive Care, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), 1, Place de L'Hôpital, 67091, Strasbourg Cedex, France.
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Mikame M, Tsuno NH, Miura Y, Kitazaki H, Uchimura D, Miyazaki T, Miyagi T, Onodera T, Ohashi W, Kameda T, Ohkawa R, Kino S, Muroi K. Decreased rate of blood donors with high ABO antibody titers in Japan and the underlying factors: Comparisons between 2010 and 2021. Transfus Apher Sci 2023; 62:103812. [PMID: 37734993 DOI: 10.1016/j.transci.2023.103812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/21/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Previously (2007), it was reported that ABO antibody titers in Japanese blood donors had decreased significantly compared to 20 years before. Here we evaluated whether further decrease of antibody titers had occurred in recent years, and the potential factors associated with changes in antibody titers. MATERIALS AND METHODS Serum/plasma from random blood donors in 2010 and 2021 (2010: 3369, 2021: 5796 donors) was classified into low, middle, and high ABO antibody titers according to the reactivity of diluted serum/plasma (2.5-fold and 20-fold) by an automated microplate system. The rates of low/high titer in the two periods were compared. Logistic regression and age-gender-BMI subgroup analyses were conducted to identify the factors that contributed to changes in antibody titers. RESULTS Compared to 2010, the rate of donors with high ABO antibody titers was decreased in 2021 for both anti-A and anti-B (anti-A, 2010: 23.8%, 2021: 19.3%; anti-B, 2010: 23.8%, 2021: 16.4%). In logistic regression analysis, age was found to significantly affect both anti-A and anti-B antibody titers (anti-A, adjusted odds ratio 0.36, 95% CI 0.31-0.41; anti-B, 0.42, 0.37-0.47), and BMI (0.82, 0.73-0.92) and other time-related factors (0.79, 0.71-0.88) significantly affect anti-B antibody titers. Subgroup analysis revealed decreased rate of high anti-B titers in the higher age group in 2021. CONCLUSION The rate of high ABO antibody titers, especially high anti-B titers, was significantly decreased in 2021, and our results suggested an association with aging and obesity of blood donors as well as other time-related factors.
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Affiliation(s)
- Masamichi Mikame
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, 2-1-67, Tatsumi, Koto-ku, Tokyo, Japan; Japanese Red Cross Central Blood Institute, 2-1-67, Tatsumi, Koto-ku, Tokyo, Japan; Clinical Bioanalysis and Molecular Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Nelson Hirokazu Tsuno
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, 2-1-67, Tatsumi, Koto-ku, Tokyo, Japan; Japanese Red Cross Central Blood Institute, 2-1-67, Tatsumi, Koto-ku, Tokyo, Japan
| | - Yoshino Miura
- Japanese Red Cross Hokkaido Block Blood Center, 1-1-20, Niju-Yonken-Nijo, Nishi-ku, Sapporo-shi, Hokkaido, Japan
| | - Hideaki Kitazaki
- Japanese Red Cross Hokkaido Block Blood Center, 1-1-20, Niju-Yonken-Nijo, Nishi-ku, Sapporo-shi, Hokkaido, Japan
| | - Daisuke Uchimura
- Japanese Red Cross Hokkaido Block Blood Center, 1-1-20, Niju-Yonken-Nijo, Nishi-ku, Sapporo-shi, Hokkaido, Japan
| | - Toru Miyazaki
- Japanese Red Cross Central Blood Institute, 2-1-67, Tatsumi, Koto-ku, Tokyo, Japan
| | - Toru Miyagi
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, 2-1-67, Tatsumi, Koto-ku, Tokyo, Japan; Japanese Red Cross Central Blood Institute, 2-1-67, Tatsumi, Koto-ku, Tokyo, Japan
| | - Takayuki Onodera
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, 2-1-67, Tatsumi, Koto-ku, Tokyo, Japan
| | - Wataru Ohashi
- Japanese Red Cross Hokkaido Block Blood Center, 1-1-20, Niju-Yonken-Nijo, Nishi-ku, Sapporo-shi, Hokkaido, Japan
| | - Takahiro Kameda
- Clinical Bioanalysis and Molecular Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan; Department of Clinical Laboratory Science, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, Japan
| | - Ryunosuke Ohkawa
- Clinical Bioanalysis and Molecular Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Shuichi Kino
- Japanese Red Cross Hokkaido Block Blood Center, 1-1-20, Niju-Yonken-Nijo, Nishi-ku, Sapporo-shi, Hokkaido, Japan
| | - Kazuo Muroi
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, 2-1-67, Tatsumi, Koto-ku, Tokyo, Japan
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Yazer MH, Panko G, Holcomb JB, Kaplan A, Leeper C, Seheult JN, Triulzi DJ, Spinella PC. Not as "D"eadly as once thought - the risk of D-alloimmunization and hemolytic disease of the fetus and newborn following RhD-positive transfusion in trauma. Hematology 2023; 28:2161215. [PMID: 36607150 DOI: 10.1080/16078454.2022.2161215] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The use of blood products to resuscitate injured and massively bleeding patients in the prehospital and early in-hospital phase of the resuscitation is increasing. Using group O red blood cells (RBC) and low titer group O whole blood (LTOWB) avoids an immediate hemolytic reaction from recipient's naturally occurring anti-A and - B, but choosing the RhD type for these products is more nuanced and requires the balancing of product availability and survival benefit against the risk of D-alloimmunization, especially in females of childbearing potential (FCP) due to the possible future occurrence of hemolytic disease of the fetus and newborn (HDFN). Recent models have estimated the risk of fetal/neonatal death from HDFN resulting from D-alloimmunization of an FCP during her trauma resuscitation at between 0-6.5% depending on her age at the time of the transfusion and other societal factors including trauma mortality, her age when she becomes pregnant, frequency of different RHD genotypes in the population, and the probability that the woman will have children with different fathers; this is counterbalanced by an approximately 24% risk of death from hemorrhagic shock. This review will discuss the different models of HDFN outcomes following RhD-positive transfusion as well as the results of recent surveys where the public was asked about their preferences for urgent transfusion in light of the risks of fetal/neonatal adverse events.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - John B Holcomb
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alesia Kaplan
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christine Leeper
- Department of Surgery, University of Pittsburgh, Pittsburgh PA, USA
| | - Jansen N Seheult
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Darrell J Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Philip C Spinella
- Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Wong TE, Wiggins-Dohlvik K, Josephson CD, Nicol KK. Blood banking considerations in pediatric trauma. J Trauma Acute Care Surg 2023; 94:S41-9. [PMID: 36221169 DOI: 10.1097/TA.0000000000003812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Transfusion of blood products to a hemorrhaging pediatric trauma patient requires seamless partnership and communication between trauma, emergency department, critical care, and transfusion team members. To avoid confusion and delays, understanding of blood banking principles and mutually agreed upon procedures and policies must be regularly updated as knowledge evolves. Because pediatric patients require specialized considerations distinct from those in adults, this brief review covers transfusion principles, policies, and procedures specific to the resuscitation of pediatric trauma patients.
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Roberts B, Green L, Ahmed V, Latham T, O'Boyle P, Yazer MH, Cardigan R. Modelling the outcomes of different red blood cell transfusion strategies for the treatment of traumatic haemorrhage in the prehospital setting in the United Kingdom. Vox Sang 2022; 117:1287-1295. [PMID: 36102164 PMCID: PMC9825834 DOI: 10.1111/vox.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/01/2022] [Accepted: 08/22/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES The limited supply and increasing demand of group O RhD-negative red blood cells (RBCs) have resulted in other transfusion strategies being explored by blood services that carry potential risks but may still provide an overall benefit to patients. Our aim was to analyse the potential economic benefits of prehospital transfusion (PHT) against no PHT. MATERIALS AND METHODS The impact of three PHT strategies (RhD-negative RBC, RhD-positive RBC and no transfusion) on quality-adjusted-life-years (QALYs) of all United Kingdom trauma patients in a given year and the subset of patients considered most at risk (RhD-negative females <50 years old), was modelled. RESULTS For the entire cohort and the subset of patients, transfusing RhD-negative RBCs generated the most QALYs (141,899 and 2977, respectively), followed by the RhD-positive RBCs (141,879.8 and 2958.8 respectively), and no prehospital RBCs (119,285 and 2503 respectively). The QALY difference between RhD-negative and RhD-positive policies was smaller (19.2, both cohorts) than RhD-positive and no RBCs policies in QALYs term (22,600 all cohort, 470 for a subset), indicating that harms from transfusing RhD-positive RBCs are lower than harms associated with no RBC transfusion. A survival increase from PHT of 0.02% (entire cohort) and 0.7% (subset cohort) would still make the RhD-positive strategy better in QALYs terms than no PHT. CONCLUSION While the use of RhD-positive RBCs carries risks, the benefits measured in QALYs are higher than if no PHT are administered, even for women of childbearing potential. Group O RhD-positive RBCs could be considered when there is a national shortage of RhD-negative RBCs.
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Affiliation(s)
- Barnaby Roberts
- Department of Health and Social CareHealth Protection AnalysisLondonUK
| | - Laura Green
- Blizard InstituteQueen Mary University of LondonLondonUK,NHS Blood and TransplantLondonUK,Barts Health NHS TrustLondonUK
| | - Venus Ahmed
- Department of Health and Social CareHealth Protection AnalysisLondonUK
| | | | - Peter O'Boyle
- Department of Health and Social CareHealth Protection AnalysisLondonUK
| | - Mark H. Yazer
- Department of PathologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Rebecca Cardigan
- NHS Blood and TransplantLondonUK,Department of HaematologyUniversity of CambridgeCambridgeUK
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Apelseth TO, Arsenovic M, Strandenes G. The Norwegian blood preparedness project: A whole blood program including civilian walking blood banks for early treatment of patients with life-threatening bleeding in municipal health care services, ambulance services, and rural hospitals. Transfusion 2022; 62 Suppl 1:S22-S29. [PMID: 35751878 PMCID: PMC9543315 DOI: 10.1111/trf.16968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
Background Civilian and military guidelines recommend early balanced transfusion to patients with life‐threatening bleeding to improve survival. To provide the best care to patients with hemorrhagic shock in regions with reduced access to evacuation, blood preparedness must be ensured also on a municipal health care level. The primary aim of the Norwegian Blood Preparedness project is to enable rural hospitals, prehospital ambulance services, and municipal health care services to start early balanced blood transfusions for patients with life‐threatening bleeding regardless of etiology. Study Design and Methods The project is designed based on three principles: (1) Early balanced transfusion should be provided for patients with life‐threatening bleeding, (2) Management of an emergency requires a planned and rehearsed day‐to‐day system for blood preparedness, and (3) A decentralized system is needed to ensure local self‐sufficiency in an emergency. We developed a system for education and training in blood‐based resuscitation with a focus on the municipal health care service. Results In this publication, we describe the implementation of emergency whole blood collections from a preplanned civilian walking blood bank in the municipal health care service. This includes donor selection, whole blood collection, emergency transfusion and quality assessment of practice. Conclusion We conclude that implementation of a Whole Blood based emergency transfusion program is feasible on all health care levels and that a preplanned civilian walking blood bank should be considered in locations were prolonged transport‐times may reduce access to blood transfusion for patients with life threatening bleeding.
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Affiliation(s)
- Torunn Oveland Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Armed Forces Joint Medical Services, Sessvollmoen, Norway.,Institute of Clinical Science, University of Bergen, Bergen, Norway
| | - Mirjana Arsenovic
- Department of Laboratory Medicine, University Hospital of North Norway, Tromso, Norway
| | - Geir Strandenes
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
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