Tag Archives: component therapy

Resuscitation

Why Do We Use Fractionated Blood Components?

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Tomorrow, I’ll be writing about the use of the newest and greatest blood product: whole blood. Wait, isn’t that what we started out a hundred years ago? How is it that we are even debating the use of blood component therapy vs whole blood? Most living trauma professionals only remember a time when blood components have been infused based on which specific ones were needed.

Prior to about 1900, blood transfusion was a very iffy thing. Transfusions from animals did not go well at all. And even from human to human, it seemed to work well at times but failed massively at others. In 1900, Landsteiner published a paper outlining the role of blood groups (types) which explained the reasons for these successes and failures. With the advent of blood storage solutions that prevented clotting, whole blood transfusion became the standard treatment for hemorrhage in World War I.

When the US entered World War II, it switched to freeze-dried plasma because of the ease of transport. However, it quickly became clear that plasma-only resuscitation resulted in much poorer outcomes. This led to the return to whole blood resuscitation. At the end of WWII, 2000 units of whole blood were being transfused per day.

In 1965, fractionation of whole blood into individual components was introduced. This allowed for guided therapy for specific conditions unrelated to trauma. It became very popular, even though there were essentially no studies of efficacy or hemostatic potential for patients suffering hemorrhage. The use of whole blood quickly faded away in both civilian and military hospitals.

The use of fresh whole blood returned for logistical reasons in the conflicts in Iraq and Afghanistan. A number of military studies were carried out that suggested improved outcomes when using whole blood in place of blood that has been reconstituted from components. That leads us to where we are today, rediscovering the advantages of whole blood.

And that’s what I’ll review tomorrow!

General

Blood Transfusion With Component Therapy vs Whole Blood

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About 40 years ago, blood banks started moving away from keeping whole blood and began separating it into components (packed cells, platelets, plasma, etc.) for more targeted use. For most uses, this is just fine. But what about trauma?

Trauma patients bleed whole blood. Doesn’t it make sense to give whole blood back? Much of our experience with massive transfusion is derived from our colleagues in the military. Two decades ago, the norm was to give 4 units of packed red cells or so, then give two units of plasma, and every once in a while slip in a bag of platelets. Our military experience seems to indicate that this 4:2:1 ratio is not optimal, and that something like 1:1:1 is better.

If you think about it, whole blood is already 1:1:1. Splitting it into components and then giving each one of them back separately seems to be a lot of extra work (and expense) to accomplish the same thing as just giving a unit of whole blood. And if you look at the purple table above, rebuilding a unit of whole blood from components isn’t nearly as good as whole blood. Plus it triples the exposure to infectious agents and antigens, since the components will usually come from (at least) three separate donors. Note that the data in the table above is true for fresh whole blood (not practical in civilian life); banked whole blood will still lose some coagulation activity. 

Is it time to think about supplying whole blood to trauma centers? And actually looking at whether the outcomes are better or not?

General
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Blood Transfusion With Component Therapy

About 40 years ago, blood banks started moving away from keeping whole blood and began separating it into components (packed cells, platelets, plasma, etc.) for more targeted use. For most uses, this is just fine. But what about trauma?

Trauma patients bleed whole blood. Doesn’t it make sense to give whole blood back? Much of our experience with massive transfusion is derived from our colleagues in the military. Two decades ago, the norm was to give 4 units of packed red cells or so, then give two units of plasma, and every once in a while slip in a bag of platelets. Our military experience seems to indicate that this 4:2:1 ratio is not optimal, and that something like 1:1:1 is better.

If you think about it, whole blood is already 1:1:1. Splitting it into components and then giving them back seems to be a lot of extra work (and expense) to accomplish the same thing as just giving a unit of whole blood. Plus it triples the exposure to infectious agents and antigens, since the components will usually come from three separate donors. Note that the data in the table above is true for fresh whole blood (not practical in civilian life); banked whole blood will lose some coagulation activity.

Is it time to think about supplying whole blood to trauma centers? And actually looking at whether the outcomes are better or not?