Jeffrey McCullough - Transfusion Medicine

106 106. Strauss RG, Goeken JA, Eckermann I, et al. Effects of intensive granulocyte donation on donors and yields. Transfusion 1986; 26:441–445.

107 107. Pulsipher MA, Chitphakdithai P, Miller JP, et al. Adverse events among 2408 unrelated donors of peripheral blood stem cells: results of a prospective trial from the National Marrow Donor Program. Blood 2009; 113(15):3604–3611.

108 108. Ghodsi Z, Strauss RG. Cataracts in neutrophil donors stimulated with adrenal corticosteroids. Transfusion 2001; 41:1464–1468.

109 109. Burch JW, Mair DC, Meny GM, et al. The risk of posterior subcapsular cataracts in granulocyte donors. Transfusion 2005; 45:1701–1708.

110 110. Shaw B, Confer D, Hwang W, et al. A review of the genetic and long‐term effects of G‐CSF injections in healthy donors: a reassuring lack of evidence for the development of haematological malignancies. Bone Marrow Transplant 2015; 50:334–340.

111 111. Bier‐Ulrich AM, Haubelt H, Anders C, et al. The impact of intensive serial plasmapheresis and iron supplementation on iron metabolism and Hb concentration in menstruating women: a prospective randomized placebo‐controlled double‐blind study. Transfusion 2003; 43:405–410.

Alesia Kaplan MD

Whole blood (WB) transfusion was a standard of care for military and civilian settings during the period between World War I and World War II. When the technology to manufacture the components became available and the need for transfusion component therapy grew with advancement of medicine, WB fell out of favor. WB had a limited use and mainly was used only for pediatric cardiothoracic surgery patients in the United States until recently [1–3]. In the past decade, a renewed interest in WB has emerged. This is due to a published military experience that showed successful use of blood products, including low titer O whole blood (LTOWB), for prehospital resuscitation [4, 5]. Military success was adapted for civilian trauma patients with severe, life‐threatening hemorrhage in prehospital and hospital settings. Retrospective data from military and civilian trauma patients indicates that LTOWB transfusion is associated with improved or noninferior survival compared with resuscitation with blood components [4–8]. Although secondary analysis of the prehospital air medical plasma trial showed that patients receiving red blood cells (RBCs) + plasma had the greatest mortality benefit [6], a prospective, randomized, controlled trial comparing mortality between LTOWB and standard therapy (1:1:1 component therapy) during air medical transport and through the early in‐hospital phase of care is being conducted [9]. Several authors pointed out that use of LTOWB in severely bleeding patients is associated with biological and logistical advantages ( Table 5.1) [10–12]. WB has less anticoagulant preservative solution and higher hematocrit, number of platelets, and coagulation factors compared with a reconstituted unit of WB with three components (RBC, platelets, and plasma). Also, it provides more effective oxygen‐carrying capacity [10–12]. In addition, studies showed that WB stored at cold temperatures (1–6°C) has functional platelets that provide improved hemostasis [2, 13]. Logistically, WB simplifies resuscitation and accelerates the provision of all blood components needed for patients with severe hemorrhage. The future application of LTOWB in different phases of care and clinical indications are still being explored.

Interestingly, in less developed parts of the world, WB is usually used and not blood components because equipment to produce components may not be available. However, in these situations, given the kind of patients being transfused, WB may be the best use of limited blood transfusion resources. In addition, the use of rapid tests for human immunodeficiency virus (HIV), hepatitis C virus, hepatitis B virus, and syphilis make fresh WB available in those situations. Additional information on the current use of WB for transfusion is available in Chapter 11.

Table 5.1 Some advantages and disadvantages of whole blood versus blood component therapy used primarily for hemorrhagic shock resuscitation.

RBC, red blood cell; TEG, thromboelastography; WB, whole blood.

Despite growing use of WB in patients with severe hemorrhage, the majority of WB collected in the United States is separated into its components, and each component is stored under conditions optimal for that component. This makes it possible to retain all of the activities of the original unit of WB and results in a large number of different components being available for transfusion therapy ( Tables 5.2and 5.3).

This chapter describes the characteristics of blood products, their preparation, and storage. Clinical uses are described in Chapters 10and 11.

WB can be collected in 450‐ and 500‐mL bags that contain citrate–phosphate–dextrose (CPD), citrate–phosphate–double dextrose (CP2D), or citrate–phosphate–dextrose adenin‐1 (CPDA‐1). WB collected in CPD and CP2D is stored for 21 days, and blood collected in CPDA‐1 is stored for 35 days at 1–6°C. No additional manufacturing step is required prior to issuing of WB. WB can be leukoreduced. There is one platelet‐sparing leukoreduction filter available in the United States (Imuflex WB‐SP, Terumo BCT). In the military, warm fresh WB is used. It is collected and stored at 22°C up to 24 hours. It can be stored at 1–6°C up to 48 hours (cold fresh WB). It is not approved by the US Food and Drug Administration (FDA) in the civilian setting because the results of infectious disease testing are not available at the time of transfusion. To mitigate risks of transfusion‐transmitted infectious diseases, military personal is tested prior to deployment and every 90 days during their deployment.

Table 5.2 Components produced by blood banks and the medical use of these components.

CMV, cytomegalovirus; HLA, human leukocyte antigen.