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Whole Blood Study // Reduce Mortality in Massively Hemorrhaging Patients

STRAC is the recipient of a $150,000 grant from the San Antonio Medical Foundation. This inter-institutional collaboration with the University of Texas Health Science Center as San Antonio (UTHSCA)/ University Health Systems (UHS), ISR/SAMMC, South Texas Blood and Tissue Center was formed to study and address the deficit in the care of injured patients in STRAC region through the development of a cold stored whole blood product and implement transfusion of cold stored whole blood in the prehospital setting on emergency helicopters.


For most of the last 250 years, whole blood was the only option for patients needing transfusions after surgery or major trauma. The transition from whole blood to component therapy — which uses stored blood that has been leukoreduced and separated into plasma, platelets and red blood cells (RBCs) — began in the 1970s. By 1990, component therapy had become standard practice in trauma surgery.

According to Donald Jenkins, M.D., director of the Level I Trauma Center at Mayo Clinic's campus in Rochester, Minnesota, the move away from whole blood wasn't driven by data comparing the risks and benefits of the different types of transfusions but by practicality — modern preservatives allow blood components to be stored up to 42 days; a newly FDA-approved preservative will allow storage out to 56 days.

Yet several large, retrospective studies question whether blood cells actually remain functional that long. A 2008 study published in The New England Journal of Medicine found that post-surgical complications and mortality were increased in patients receiving blood stored more than two weeks — possibly due to high concentrations of hemoglobin, free iron and red blood cell fragments.

Furthermore, component blood, even when given in a 1-1-1 transfusion ratio (equal parts plasma, platelets and packed RBCs) — the standard of care in the resuscitation of severe hemorrhage — replicates but does not duplicate whole blood. In the May 2014 issue of Surgery, Mayo Clinic researchers note that component blood contains "a myriad of additives," including dextrose, mannitol, sodium phosphate, sodium bicarbonate, sodium chloride, citric acid, phosphate, dextrose and adenine. This fluid is also anemic, thrombocytopenic and acidotic, with 40 percent less concentration of coagulation proteins.

The better alternative to this chemical solution, the authors argue, is real whole blood — either stored or fresh.


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