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Regional Whole Blood Program Low Titer O Positive Whole Blood (LTOWB)

STRAC is the recipient of a $150,000 grant from the San Antonio Medical Foundation. This inter-institutional collaboration with the South Texas Blood and Tissue Center, UT Health San Antonio, University Health Systems (UHS), and the US Army Institute of Surgical Research / San Antonio Military Medical Center was formed to study and address the optimizing care of seriously injured or ill patients in STRAC region. This care need is met through the development of a cold stored whole blood product and implement transfusion of cold stored whole blood in the prehospital setting for helicopters emergency medical services. Funding from the Remote Trauma Outcomes Research Network (through the Department of Defense) allowed for an expansion to ground emergency medical services.

Frequently Asked Questions

Low anti-body titer cold stored O+ whole blood is an FDA licensed and AABB approved blood product for administration in emergency release situations when other blood products are unavailable and/or the patient’s blood type is unknown. It is the unit of blood drawn from the donor which has been tested like any other blood product and a preservative is added (just like any other blood product) so it contains the red cells, plasma, platelets and white cells from the donor just like it was when it was circulating in their veins.
Our study of our patients indicate that waiting until a patient gets to the hospital to give the first transfusion has a very high death rate (over 70%). Cold stored whole blood can safely provide oxygen carrying capacity and restore coagulation at the same time.
No. This was the only blood product available from the inception of blood transfusion into the 1970’s. Patient transfusion risks actually decrease since they are receiving a transfusion from one donor source instead of three.
Each bag contains roughly 520 cc of total volume. Equivalent to 1 unit of PRBCs and 1 FFP.
Cold stored whole blood contains plasma and platelets.
Logistics. The effective shelf life of platelets, the number one coagulation factor needed by bleeding trauma patients, is three days. Patients bleed whole blood; we replace it with whole blood.
No. It is also not leukocyte reduced.
Yes, it should be. It can be used through all FDA approved warming/infusion devices.
Yes. Platelet function in cold stored whole blood on day 35 is the same as platelet function in a regular unit on day 5 when it must be used or discarded.
In the traditional sense, no, because it is Rh+, not Rh-
Yes. The risk benefit to the patient favors risk of antibody formation versus death due to hemorrhage.
You should consult with your transfusion medicine and/or obstetrics expert.
Children under the age of three probably should not get emergency release whole blood due to the development of their immune system.
The same kind of reactions that can occur during transfusion of any blood product.
No. Administration is the same as with all other blood/blood products.
In small quantities, no. However, just as with any uncrossmatched, emergency release blood product, this issue can arise if the patient gets replacement of their full blood volume. It is typically not a life threatening condition.


Case Report: Prehospital Whole Blood Transfusion by Texas Helicopter Air Ambulance Crew

Authors: Capt. Alex Merkle, PA-C, Randi Schaefer, MSN, RN, ACNS-BC, CEN, Maj. Remealle How, MD and Terrell Fritz, NRP, FP-C | 11.21.19

The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio, TX

Authors: Douglas M. Pokorny, Maxwell A. Braverman, Philip M. Edmundson, David M. Bittenbinder, Caroline S. Zhu, Christopher J. Winckler, Randall Schaefer, Ashley C. McGinity, Eric Epley, Brian J. Eastridge, Susannah E. Nicholson, Ronald M. Stewart, & Donald H. Jenkins (2019)

Give the trauma patient what they bleed, when and where they need it: establishing a comprehensive regional system of resuscitation based on patient need utilizing cold-stored, low-titer O+ whole blood

Authors: Caroline S. Zhu, Douglas M. Pokorny, Brian J. Eastridge, Susannah E. Nicholson, Eric Epley, Jason Forcum, Tasia Long, David Miramontes, Randall Schaefer, Michael Shiels, Ronald M. Stewart, Michael Stringfellow, Rena Summers, Christopher J. Winckler, and Donald H. Jenkins (2019)

Vox Sanguinis International Forum on the use of prehospital blood products and pharmaceuticals in the treatment of patients with traumatic hemorrhage

Authors: Yazer, M. H., Spinella, P. C., Allard, S. , Roxby, D. , So‐Osmon, C. , Lozano, M. , Gunn, K. , Shih, A. W., Stensballe, J. , Johansson, P. I., Bagge Hansen, M. , Maegele, M. , Doughty, H. , Crombie, N. , Jenkins, D. H., McGinity, A. , Schaefer, R. M., Martinaud, C. , Shinar, E. , Strugo, R. , Chen, J. and Russcher, H. (2018)

Pre-hospital Low Titer Cold Stored Whole Blood: Philosophy for Ubiquitous Utilization of O Positive Product for Emergency Use in Hemorrhage due to Injury.

The mortality from hemorrhage in trauma patients remains high. Early balanced resuscitation improves survival. These truths, balanced with the availability of local resources and our goals for positive regional impact, were the foundation for the development of our pre-hospital whole blood initiative-using low titer cold stored O RhD positive whole blood (LTOWB). The main concern with use of RhD positive blood is the potential development of isoimmunization in RhD negative patients. We used our retrospective massive transfusion protocol (MTP) data to analyze the anticipated risk of this change in practice. In 30 months, out of 124 total MTP patients, only one female of childbearing age that received an MTP was RhD negative. With the risk of isoimmunization very low and the benefit of increased resources for the early administration of balanced resuscitation high, we determined that utilization of LTOWB would be safe and best serve our community.

Brothers In Arms

San Antonio is becoming one of the first communities in the country to transfer military battlefield research to civilian use.

The South Texas Blood and Tissue Center on January 29, 2018 launched the "Brothers In Arms" blood donor program.

The program will give medical helicopter crews a new tool to fight blood loss and save the lives of critically injured patients by providing them with whole blood for pre-hospital transfusions.

Committees and Workgroups

Regional Whole Blood Committee
Chair: Donald Jenkins, MD, FACS, UT Health San Antonio
Meets: Quarterly (Feb/June/Oct)
San Antonio, First Friday 11:00AM-12:00PM

Participating Organizations

Organization Type Status
Air Medical Carries LTOWB
Air Medical Carries LTOWB
Lvl IV Trauma Ctr Carries LTOWB
Lvl IV Trauma Ctr Carries LTOWB
Air Medicalr Carries LTOWB
Lvl I Trauma Ctr Carries LTOWB
Lvl I Trauma Ctr Carries LTOWB