Since its introduction in the early part of the last century, fresh whole blood (FWB) has been used by the US military as a battlefield expedient resuscitation method, even after the development of component therapy in the 1960s. In the recent conflicts in Iraq and Afghanistan, FWB was used once more, often collected in the setting of a walking blood bank (WBB). Considerable research and opinion from military circles has cited these experiences and sparked renewed interest in FWB as an effective resuscitation tool in the setting of trauma. Despite efforts by the US military to improve the effectiveness and safety of FWB through a series of widely published guidelines, transfusion transmitted infections (TTI) remain a vexing challenge. These experiences in Iraq and Afghanistan will help inform a larger discussion regarding the reintroduction of FWB in civilian trauma resuscitation.
Operation New Dawn (OND) and Operation Enduring Freedom (OEF) transfusion data analysis as of 31 October2011Level I–Level III; slide number 33.
2.
Shock and resuscitation. In: Emergency War Surgery, Third United States Revision. Washington, DC: Department of the Army, Office of the Surgeon General, Borden Institute; 2004:7.1-7.12.
HessJRSchmidtPJ. The first blood banker: Oswald Hope Robertson. Transfusion. 2000;40:110-113.
9.
KendrickDB. Blood Program in World War II. Washington, DC: Office of the Surgeon General; 1964.
10.
HessJRThomasMJG. Blood use in war and disaster: lessons from the past century. Transfusion. 2003;43: 1622-1633.
11.
MabryRLHolcombJBBakerAM. United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma. 2000;49:515-529.
12.
GrossoSMKeenanJO. Whole blood transfusion for exsanguinating coagulopathy in a US field surgical hospital in postwar Kosovo. J Trauma. 2000;49:145-148.
13.
SpinellaPCPerkinsJGGrathwohlKWBeekleyACHolcombJB. Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. J Trauma. 2009;66(4 suppl):S69-S76.
14.
ArmandRHessJR. Treating coagulopathy in trauma patients. Transfus Med Rev. 2003;17:223-231.
15.
SpinellaPC. Warm fresh whole blood: military and civilian applications. Crit Care Med. 2008;36(7 suppl):S340-S345.
16.
BeekleyAC. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit Care Med. 2008;36(7 suppl):S267-S274.
17.
HughesJDMacdonaldVWHessJR. Warm storage of whole blood for 72 hours. Transfusion. 2007;47:2050-2056.
18.
SpinellaPCPerkinsJGGrathwohlKW; 31st Combat Support Hospital Research Working Group. Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. Crit Care Med. 2007;35:2576-2581.
19.
HetzSP. Introduction to military medicine: a brief overview. Surg Clin North Am. 2006;86:675-688.
PerkinsJGAndrewCPSpinellaPC; 31st Combat Support Hospital Research Group. Comparison of platelet transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients. Transfusion. 2011;51:242-252.
BorgmanMASpinellaPCPerkinsJG. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63:805-813.
24.
SpinellaPCPerkinsJGGrathwohlKW. Effect of plasma and red blood cell transfusions on survival in patients with combat related traumatic injuries. J Trauma. 2008;64(2 suppl):S69-S78.
25.
PerkinsJGAndrewCPSpinellaPC. An evaluation of the impact of apheresis platelets used in the setting of massively transfused trauma patients. J Trauma. 2009;66 (4 suppl):S77-S85.
26.
KauvarDSHolcombJBNorrisGCHessJR. Fresh whole blood transfusion: a controversial military practice. J Trauma. 2006;61:181-184.
27.
RepineTBPerkinsJGKauvarDSBlackborneL. The use of fresh whole blood in massive transfusion. J Trauma. 2006;60(6 suppl):S59-S69.
28.
United States Army. Army Regulation 600-110: Identification, Surveillance, and Administration of Personnel Infected with Human Immunodeficiency Virus (HIV): July15, 2005. Washington, DC: Department of the Army; 2005. Paragraph 2-2h,i.
29.
US Department of Defense. United States Central Command Policy 021922Z December 2011. Modification eleven to USCENTCOM individual protection and individual/unit deployment policy. Washington, DC: Department of Defense; 2011.
30.
US Department of Defense. Memorandum HA Policy 02-010. April29, 2002. Subject: Vaccination of New Recruits Against Hepatitis B. Washington, DC: Department of Defense; 2002.
31.
O’ConnellRJGatesRGImbachM. Poster: Laboratory evaluation of hepatitis B rapid tests for use in screening walking blood bank donors. Division of Retrovirology, Walter Reed Army Institute of Research; August2008.
32.
O’ConnellRJGatesRGImbachM. Poster: Laboratory evaluation of hepatitis C rapid tests for use in screening walking blood bank donors. Division of Retrovirology, Walter Reed Army Institute of Research; August2008.
HakreSPeelSAO’ConnellRJ. Transfusion-transmissible viral infections among US military recipients of whole blood and platelets during Operation Enduring Freedom and Operation Iraqi Freedom. Transfusion. 2011;51:473-485.
UtterGHLeeTHRiversRM. Microchimerism decades after transfusion among combat-injured US veterans from the Vietnam, Korean, and World War II conflicts. Transfusion. 2008;48:1609-1615.
37.
DunneJRLeeTHBurnsCCardoLJCurryKBuschMP. Transfusion-associated microchimerism in combat casualties. J Trauma. 2008;64(2 suppl):S92-S98.
