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Degueldre J, Dessy E, T'Sas F, Keesebilck E, Deneys V. When do benefits turn to risks? Impact of a 900 mL whole blood donation on Special Forces performance. Transfusion 2024; 64:656-664. [PMID: 38385641 DOI: 10.1111/trf.17757] [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: 11/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Special Forces (SF) teams operate in remote environments with limited medical support. As a result, they may need to rely on buddy transfusions to treat bleeding teammates. Considering that 450 mL has no direct impact on their combat performances, it might be tempting to take more blood from a compatible donor to save a hemorrhaging teammate. This study investigates the effect of a 900 mL blood donation on SF operator performance and recovery time following this donation. STUDY DESIGN AND METHODS Participants underwent a multifactorial assessment including measures of physiological parameters, vigilance, and physical performance. Results from the day of blood donation were compared with baseline values obtained 1 week earlier (i.e., immediate effect), as well as repeated testing at 7, 14, and approximately 30 days after blood donation (i.e., recovery period). RESULTS Hemoglobin levels and heart rate were affected by giving blood. The participants also experienced a significant decrease in physical performance of more than 50% immediately after blood donation. Recovery was slow over the following weeks, remaining significantly different from baseline until full recovery around day 30. However, participants were still able to respond to a simple stimulus and adjust their response, if necessary, even immediately after donating blood. DISCUSSION A 900 mL blood donation greatly affects the physical fitness of SF operators. A donation may be worthwhile if it is the only life-saving procedure available and does not endanger the donor's life. The donor would then become a patient and unable to complete the mission.
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Affiliation(s)
- Julie Degueldre
- Military Medical Laboratory Capacity - Ops Dept, MHQA, Military Hospital Queen Astrid, Brussels, Belgium
- Cliniques Universitaires Saint Luc, UCL, Université Catholique de Louvain, Brussels, Belgium
| | - E Dessy
- Military Medical Laboratory Capacity - Ops Dept, MHQA, Military Hospital Queen Astrid, Brussels, Belgium
| | - F T'Sas
- Military Medical Laboratory Capacity - Ops Dept, MHQA, Military Hospital Queen Astrid, Brussels, Belgium
| | - E Keesebilck
- Burn Unit BWC-HC, MHQA, Military Hospital Queen Astrid, Brussels, Belgium
| | - V Deneys
- Cliniques Universitaires Saint Luc, UCL, Université Catholique de Louvain, Brussels, Belgium
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Chang RK, Boyle BP, Udoh MO, Maestas JM, Gehrz JA, Ruano E, Banker L, Cap AP, Bitterman JW, Deaton TG, Auten JD. Prescreened Whole O Blood Group Walking Blood Bank Capabilities for Nontraditional Maritime Medical Receiving Platforms: A Case Series. J Spec Oper Med 2024:PC7T-LML9. [PMID: 38408045 DOI: 10.55460/pc7t-lml9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Tactical Combat Casualty Care (TCCC) guidelines recognize low-titer group O whole blood (LTOWB) as the resuscitative fluid of choice for combat wounded. Utilization of prescreened LTOWB in a walking blood bank (WBB) format has been well described by the Ranger O low-titer blood (ROLO) and the United States Marine Corps Valkyrie programs, but it has not been applied to the maritime setting. METHODS We describe three WBB experiences of an expeditionary resuscitative surgical system (ERSS) team, attached to three nontraditional maritime medical receiving platforms, over 6 months. RESULTS Significant variations were identified in the number of screened eligible donors, the number of LTOWB donors, and the timely arrival at WBB activation sites between the platforms. Overall, 95% and 84% of the screened eligible group O blood donors on the Arleigh Burke Class Destroyer (DDG) and Nimitz Class Aircraft Carrier (CVN), respectively, were determined to be LTOWB. However, only 37% of the eligible screened group O blood donors aboard the Harper's Ferry Class Dock Landing Ship (LSD) were found to be LTOWB. Of the eligible donors, 66% did not complete screening, with 52% citing a correctable reason for nonparticipation. CONCLUSION LTOWB attained through WBBs may be the only practical resuscitative fluid on maritime platforms without inherent blood product storage capabilities to perform remote damage control resuscitation. Future efforts should focus on optimizing WBBs through capability development, education, and training efforts.
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Wier R, Walther S, Woodard C, Jordan CS, Matthews KJ, Deaton TG, Drew B, Byrne T, Zarow GJ. When Minutes Matter: A Comparison of Whole Blood Collection Techniques. J Spec Oper Med 2024:N87K-W6BZ. [PMID: 38446068 DOI: 10.55460/n87k-w6bz] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Fast and reliable blood collection is critical to emergency walking blood banks (WBB) because mortality significantly declines when blood is quickly administered to a warfighter with hemorrhagic shock. Phlebotomy for WBB is accomplished via either the "straight stick" (SS) or "ruggedized lock" (RL) method. SS comprises a 16-gauge phlebotomy needle connected to a blood collection bag via tubing. The RL device collects blood through the same apparatus, but has a capped, intravenous (IV) catheter between the needle and the donor's arm. This is the first study to compare these two methods in battlefield-relevant metrics. METHODS Military first responders and licensed medical providers (N=86) were trained in SS and RL as part of fresh whole blood training exercises. Outcomes included venipuncture success rates, time to IV access, blood collection times, total time, and user preferences, using a within-subjects crossover design. Data were analyzed using ANOVA and nonparametric statistics at p<0.05. RESULTS SS outperformed RL in first venipuncture success rates (76% vs. 64%, p=0.07), IV access times (448 [standard error of the mean; SE 23] vs. 558 [SE 31] s, p<0.01), and blood collection bag fill times (573 [SE 48] vs. 703 [SE 44] s, p<0.05), resulting in an approximate 3.5-minute faster time overall. Survey data were mixed, with users perceiving SS as simpler and faster, but RL as more reliable and secure. CONCLUSION SS is optimal when timely collection is imperative, while RL may be preferable when device stability or replacing the collection bag is a consideration.
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Apelseth TO, Kristoffersen EK, Strandenes G, Hervig T. Training of medical students in the use of emergency whole blood collection and transfusion in the framework of a civilian walking blood. Transfusion 2023; 63 Suppl 3:S60-S66. [PMID: 37057630 DOI: 10.1111/trf.17343] [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: 12/31/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION In this report, we describe a training program in emergency whole blood collection and transfusion for medical students at the University of Bergen. The overall aim of the program is to improve the availability of early balanced blood transfusion for the treatment of patients with life-threatening bleeding in rural health care services. STUDY DESIGN AND METHODS The voluntary training program provides the knowledge needed to practice emergency whole blood transfusions and understand the system for emergency whole blood collection in the framework of a civilian walking blood bank (WBB). It includes theoretical and practical sessions. In-person teaching and web-based learning resources are provided. An anonymous survey of the students attending the training course in the autumn of 2022 and spring 2023 was performed. RESULTS 128 of 178 students participated in the practical training. 88 of 128 (69%) responded to the survey. 82 (93%) performed blood typing, 71 (81%) performed donor interviews, 61 (69%) partially performed whole blood collection (up to blood in bag) and 27 (30%) participated in complete whole blood collection and performed autologous reinfusion. No complications occurred during training. The students reported that the training course increased their understanding of how to ensure access to emergency blood transfusion by the use of a WBB. DISCUSSION Structured theoretical and practical training in emergency whole blood collection and emergency transfusion is feasible and of interest to medical students. A multidisciplinary approach to student training in emergency whole blood collection and transfusion should be considered.
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Affiliation(s)
- Torunn O Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
- Norwegian Armed Forces Joint Medical Services, Sessvollmoen, Norway
- Institute of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Einar K Kristoffersen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
- Institute of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Geir Strandenes
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Tor Hervig
- Irish Blood Transfusion Service, Dublin, Ireland
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5
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Avila CO, Sayson SC, Bennett B. Whole Blood Storage Temperature Investigation in Austere Environments. J Spec Oper Med 2022; 22:19-21. [PMID: 35862848 DOI: 10.55460/z785-2pxq] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Military medical research has affirmed that early administration of blood products and timely treatment save lives. The US Navy's Expeditionary Resuscitative Surgical System (ERSS) is a Role 2 Light Maneuver team that functions close to the point of injury, administering blood products and providing damage-control resuscitation and surgery. However, information is lacking on the logistical constraints regarding provisions for and the stability of blood products in austere environments. METHODS ERSS conducted a study on the United States Central Command (USCENTCOM) area of responsibility. Expired but properly stored units of stored whole blood (SWB) were subjected to five different storage conditions, including combinations of passive and active refrigeration. The SWB was monitored continuously, including for external ambient temperatures. The time for the SWB to rise above the threshold temperature was recorded. RESULTS The main outcome of the study was the time for the SWB to rise above the recommended storage temperature. Average ambient temperature during the experiment involving conditions 1 through 4 was 25.6°C (78.08°F). Average ambient temperature during the experiment involving condition 5 was 34.8°C (94.64°F). Blood temperature reached the 6°C (42.8°F) threshold within 90 minutes in conditions 1 and 2, which included control and chemically activated ice packs in the thermal insulated chamber (TIC). Condition 2 included prechilling the TIC in a standard refrigerator to 4°C (39.2°F), which kept the units of SWB below the threshold temperature for 490 minutes (approximately 8 hours). Condition 4 entailed prechilling the TIC in a standard freezer to 0.4°C (32.72°F), thus keeping the units of SWB below threshold for 2,160 minutes (i.e., 36 hours). Condition 5 consisted of prechilling the TIC to 3.9°C (39.02°F) in the combat blood refrigerator, which kept the SWB units below the threshold for 780 minutes (i.e., 13 hours), despite a higher average ambient temperature of almost +10°C (50°F). CONCLUSION Combining active and passive refrigeration methods will increase the time before SWB rises above the threshold temperature. We demonstrate an adaptable approach of preserving blood product temperature despite refrigeration power failure in austere settings, thereby maintaining mission readiness to increase the survival of potential casualties.
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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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Taylor AL, Corley JB, Cap AP, Swingholm MT, Nance ET, Gonzales R, Gurney JM, Shackelford S, Hebert JC, Hughes JD, Royster K, Hestilow GA, Cordrick CL, Hoiles J, Whitlock K, Whitacre R, Pederson B. The U.S. Armed Services Blood Program support to U.S. Central Command 2014-2021: Transformation of combat trauma resuscitation through blood product innovation and expansion of blood availability far forward. Transfusion 2022; 62 Suppl 1:S167-S176. [PMID: 35748678 DOI: 10.1111/trf.16951] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The United States Armed Services Blood Program (ASBP) faced complex blood supply challenges during two decades of military operations in the U.S. Central Command (CENTCOM) and through an adaptive, responsive, and agile system, gained valuable insights on blood product usage in combat casualty care. STUDY DESIGN AND METHODS A retrospective review of blood product introduction and utilization trends was compiled from ASBP data collected during CENTCOM operations from 2014 through 2021. RESULTS During the study period, several blood products were introduced to the CENTCOM area of operations including Low Titer O Whole Blood (LTOWB), Cold-Stored Platelets (CSP), Liquid Plasma (LP), and French Freeze Dried Plasma (FDP) manufactured from U.S. sourced donor plasma, all while expanding Walking Blood Bank capabilities. There was a gradual substitution of component therapy for whole blood; blood utilization peaked in 2017. Transfusion of Fresh Whole Blood (FWB) from Walking Blood Banks decreased as fully pre-tested LTOWB was supplied by the ASBP. LTOWB was initially supplied in citrate-phosphate-dextrose (CPD) anticoagulant (21-day shelf life) but was largely replaced with LTOWB in citrate-phosphate-dextrose-adenine (CPDA-1) anticoagulant (35-day shelf life) by 2019. Implementation of prehospital transfusion and expansion of surgical and resuscitation teams led to an increase in the number of sites receiving blood. DISCUSSION ASBP introduced new products to its inventory in order to meet changing blood product demands driven by changes in the Joint Trauma System Clinical Practice Guidelines and operational demands. These products were adopted into clinical practice with a resultant evolution in transfusion strategies.
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Affiliation(s)
- Audra L Taylor
- Armed Services Blood Program Division, Defense Health Agency, Falls Church, Virginia, USA
| | - Jason B Corley
- U.S. Army Medical Command, Army Blood Program, San Antonio, Texas, USA
| | - Andrew P Cap
- Army Institute of Surgical Research Army Blood Program, San Antonio, Texas, USA
| | | | - Erika T Nance
- Armed Services Blood Program Division, Defense Health Agency, Falls Church, Virginia, USA
| | | | - Jennifer M Gurney
- Army Institute of Surgical Research Army Blood Program, San Antonio, Texas, USA
| | | | - Jeffrey C Hebert
- Bureau of Medicine & Surgery, Navy Blood Program, Falls Church, Virginia, USA
| | | | - Karen Royster
- Armed Services Blood Program Division, Defense Health Agency, Falls Church, Virginia, USA
| | - George A Hestilow
- Air Force Medical Readiness Agency, Air Force Blood Program, San Antonio, Texas, USA
| | - Colleen L Cordrick
- Center for Laboratory Medicine Services, Defense Health Agency, Falls Church, Virginia, USA
| | | | | | - Robin Whitacre
- Armed Services Blood Program Division, Defense Health Agency, Falls Church, Virginia, USA
| | - Becky Pederson
- Air Force Medical Readiness Agency, Air Force Blood Program, San Antonio, Texas, USA
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Degueldre J, Dessy E, T'Sas F, Deneys V, Pattyn N. Minimal tactical impact and maximal donor safety after a buddy transfusion: A study on elite soldier performances in both laboratory and field environments. Transfusion 2021; 61 Suppl 1:S32-S42. [PMID: 34269455 DOI: 10.1111/trf.16463] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The major causes of death of combat casualties in austere environments are related to hemorrhage and occur early after injury. The implementation of a walking blood bank may overcome the logistical issues raised using blood component therapy. Nonetheless, it is important to ensure that this buddy transfusion is not going to compromise the mission success by altering the donor's performance. The results available so far cannot rule out this issue with certainty. Therefore, this study aimed at investigating the immediate effect of a 450-ml blood donation on the performances of elite soldiers in laboratory and field environments. STUDY DESIGN AND METHODS This double-blind, randomized controlled study included two experiments. For both experiments, subjects were randomly assigned either to a control group (n1 = n2 = 7) or to a 450-ml-blood-bag donation group (n1 = 7 and n2 = 8). All participants underwent before and after a potential blood donation a multifactorial assessment including adapted physical tasks, hematological variables, vigilance parameters, and subjective assessments. RESULTS No significant results were evidenced in this study. There was no impact of blood donation on the participants' performances in both the hospital and the combat-like environments. CONCLUSION From a donor's point of view, a 450-ml blood donation has no impact on the required abilities of our elite soldiers to fulfill a demanding tactical mission. Thus, the results of this study support the fact that buddy transfusions could be part of the operational clinical armamentarium in austere environments for elite soldiers when no blood components are available.
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Affiliation(s)
- Julie Degueldre
- HRMA, Military Medical Laboratory Capacity, Brussels, Belgium.,UCL, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.,VIPER Research Unit, Royal Military Academy, Brussels, Belgium
| | - Emilie Dessy
- VIPER Research Unit, Royal Military Academy, Brussels, Belgium
| | - France T'Sas
- HRMA, Military Medical Laboratory Capacity, Brussels, Belgium
| | - Véronique Deneys
- UCL, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nathalie Pattyn
- VIPER Research Unit, Royal Military Academy, Brussels, Belgium.,Human Physiology Department, Vrije Universiteit Brussel, Brussels, Belgium
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9
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Braathen H, Sivertsen J, Lunde THF, Strandenes G, Lindemann PC, Assmus J, Hervig TA, Apelseth TO. Effect of leukoreduction and temperature on risk of bacterial growth in CPDA-1 whole blood: A study of Escherichia coli. Transfusion 2021; 61 Suppl 1:S80-S89. [PMID: 34269444 DOI: 10.1111/trf.16499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Collection of non-leukoreduced citrate-phosphate-dextrose-adenine (CPDA-1) whole blood is performed in walking blood banks. Blood collected under field conditions may have increased risk of bacterial contamination. This study was conducted to examine the effects of WBC reduction and storage temperature on growth of Escherichia coli (ATCC® 25922™) in CPDA-1 whole blood. METHODS CPDA-1 whole blood of 450 ml from 10 group O donors was inoculated with E. coli. Two hours after inoculation, the test bags were leukoreduced with a platelet-sparing filter. The control bags remained unfiltered. Each whole blood bag was then split into three smaller bags for further storage at 2-6°C, 20-24°C, or 33-37°C. Bacterial growth was quantified immediately, 2 and 3 h after inoculation, on days 1, 3, 7, and 14 for all storage temperatures, and on days 21 and 35 for storage at 2-6°C. RESULTS Whole blood was inoculated with a median of 19.5 (range 12.0-32.0) colony-forming units per ml (CFU/ml) E. coli. After leukoreduction, a median of 3.3 CFU/ml (range 0.0-33.3) E. coli remained. In the control arm, the WBCs phagocytized E. coli within 24 h at 20-24°C and 33-37°C in 9 of 10 bags. During storage at 2-6°C, a slow self-sterilization occurred over time with and without leukoreduction. CONCLUSIONS Storage at 20-24°C and 33-37°C for up to 24 h before leukoreduction reduces the risk of E. coli-contamination in CPDA-1 whole blood. Subsequent storage at 2-6°C will further reduce the growth of E. coli.
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Affiliation(s)
- Hanne Braathen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Joar Sivertsen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Turid Helen Felli Lunde
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Geir Strandenes
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of War Surgery and Emergency Medicine, Norwegian Armed Forces Medical Services, Oslo, Norway
| | | | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tor Audun Hervig
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Sciences, University of Bergen, Bergen, Norway.,Department of Immunology and Transfusion Medicine, Haugesund Hospital, Haugesund, Norway
| | - Torunn Oveland Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of War Surgery and Emergency Medicine, Norwegian Armed Forces Medical Services, Oslo, Norway
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Shackelford SA, Gurney JM, Taylor AL, Keenan S, Corley JB, Cunningham CW, Drew BG, Jensen SD, Kotwal RS, Montgomery HR, Nance ET, Remley MA, Cap AP. Joint Trauma System, Defense Committee on Trauma, and Armed Services Blood Program consensus statement on whole blood. Transfusion 2021; 61 Suppl 1:S333-S335. [PMID: 34269445 DOI: 10.1111/trf.16454] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/29/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/21/2022]
Abstract
Hemorrhage is the most common mechanism of death in battlefield casualties with potentially survivable injuries. There is evidence that early blood product transfusion saves lives among combat casualties. When compared to component therapy, fresh whole blood transfusion improves outcomes in military settings. Cold-stored whole blood also improves outcomes in trauma patients. Whole blood has the advantage of providing red cells, plasma, and platelets together in a single unit, which simplifies and speeds the process of resuscitation, particularly in austere environments. The Joint Trauma System, the Defense Committee on Trauma, and the Armed Services Blood Program endorse the following: (1) whole blood should be used to treat hemorrhagic shock; (2) low-titer group O whole blood is the resuscitation product of choice for the treatment of hemorrhagic shock for all casualties at all roles of care; (3) whole blood should be available within 30 min of casualty wounding, on all medical evacuation platforms, and at all resuscitation and surgical team locations; (4) when whole blood is not available, component therapy should be available within 30 min of casualty wounding; (5) all prehospital medical providers should be trained and logistically supported to screen donors, collect fresh whole blood from designated donors, transfuse blood products, recognize and treat transfusion reactions, and complete the minimum documentation requirements; (6) all deploying military personnel should undergo walking blood bank prescreen laboratory testing for transfusion transmitted disease immediately prior to deployment. Those who are blood group O should undergo anti-A/anti-B antibody titer testing.
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Affiliation(s)
- Stacy A Shackelford
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas, USA
- Uniformed Services University, Bethesda, Maryland, USA
| | - Jennifer M Gurney
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas, USA
- U.S. Army Institute of Surgical Research, San Antonio, Texas, USA
| | - Audra L Taylor
- Armed Services Blood Program, Defense Health Agency Combat Support, Falls Church, Virginia, USA
| | - Sean Keenan
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas, USA
| | - Jason B Corley
- Army Blood Program, US Army Medical Command, San Antonio, Texas, USA
| | - Cord W Cunningham
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas, USA
| | - Brendon G Drew
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas, USA
- Force Surgeon, I Marine Expeditionary Force, San Diego, CA
| | - Shane D Jensen
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas, USA
| | - Russ S Kotwal
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas, USA
- Uniformed Services University, Bethesda, Maryland, USA
| | - Harold R Montgomery
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas, USA
| | - Erika T Nance
- Armed Services Blood Program, Defense Health Agency Combat Support, Falls Church, Virginia, USA
| | - Michael A Remley
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas, USA
| | - Andrew P Cap
- Uniformed Services University, Bethesda, Maryland, USA
- U.S. Army Institute of Surgical Research, San Antonio, Texas, USA
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11
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Holcomb JB, Spinella PC, Apelseth TO, Butler FK, Cannon JW, Cap AP, Corley JB, Doughty H, Fitzpatrick M, Goldkind SF, Gurney JM, Homer MJ, Ilstrup SJ, Jansen JO, Jenkins DH, Marques MB, Moore EE, Ness PM, O'Connor KC, Schreiber MA, Shinar E, Sloan S, Strandenes G, Stubbs JR, Taylor AL, Ward KR, Waltman E, Yazer M. Civilian walking blood bank emergency preparedness plan. Transfusion 2021; 61 Suppl 1:S313-S325. [PMID: 34269450 DOI: 10.1111/trf.16458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/15/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The current global pandemic has created unprecedented challenges in the blood supply network. Given the recent shortages, there must be a civilian plan for massively bleeding patients when there are no blood products on the shelf. Recognizing that the time to death in bleeding patients is less than 2 h, timely resupply from unaffected locations is not possible. One solution is to transfuse emergency untested whole blood (EUWB), similar to the extensive military experience fine-tuned over the last 19 years. While this concept is anathema in current civilian transfusion practice, it seems prudent to have a vetted plan in place. METHODS AND MATERIALS During the early stages of the 2020 global pandemic, a multidisciplinary and international group of clinicians with broad experience in transfusion medicine communicated routinely. The result is a planning document that provides both background information and a high-level guide on how to emergently deliver EUWB for patients who would otherwise die of hemorrhage. RESULTS AND CONCLUSIONS Similar plans have been utilized in remote locations, both on the battlefield and in civilian practice. The proposed recommendations are designed to provide high-level guidance for experienced blood bankers, transfusion experts, clinicians, and health authorities. Like with all emergency preparedness, it is always better to have a well-thought-out and trained plan in place, rather than trying to develop a hasty plan in the midst of a disaster. We need to prevent the potential for empty shelves and bleeding patients dying for lack of blood.
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Affiliation(s)
- John B Holcomb
- Center for Injury Science, Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip C Spinella
- Division of Critical Care, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Torunn Oveland Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
- Norwegian Armed Forces Medical Service, Sessvollmoen, Norway
| | | | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew P Cap
- Uniformed Services University, Bethesda, Maryland, USA
- US Army Institute of Surgical Research, San Antonio, Texas, USA
- Ft Sam Houston, San Antonio, Texas, USA
| | - Jason B Corley
- Army Blood Program, US Army Medical Command, JBSA - Fort Sam Houston, San Antonio, Texas, USA
| | - Heidi Doughty
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | | | | | | | - Mary J Homer
- Division of Chemical, Biological, Radiological, and Nuclear Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, District of Columbia, USA
| | - Sarah J Ilstrup
- Department of Laboratory Medicine and Pathology, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Jan O Jansen
- Division of Acute Care Surgery; and Director, Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donald H Jenkins
- Division of Trauma and Emergency Surgery, UT Health, San Antonio, Texas, USA
| | - Marisa B Marques
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eugene E Moore
- Shock Trauma Center at Denver Health, Department of Surgery, University of Colorado Denver, Denver, Colorado, USA
| | - Paul M Ness
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin C O'Connor
- George Washington University School of Medicine and Health Sciences, Medical Faculty Associates, Washington, District of Columbia, USA
| | | | | | - Steve Sloan
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Geir Strandenes
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
- Department of War Surgery and Emergency Medicine, Norwegian Armed Forces Medical Services, Oslo, Norway
| | - James R Stubbs
- Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Audra L Taylor
- Armed Services Blood Program, Defense Health Agency, Falls Church, Virginia, USA
| | - Kevin R Ward
- George Washington University School of Medicine and Health Sciences, Medical Faculty Associates, Washington, District of Columbia, USA
| | - Elizabeth Waltman
- BioBridge Global, Inc., San Antonio, Texas, USA
- South Texas Blood & Tissue Center, San Antonio, Texas, USA
| | - Mark Yazer
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Tel Aviv University, Tel Aviv, Israel
- University of Southern Denmark, Odense, Denmark
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