Whole blood: back to the future

We present data comparing whole blood with blood components and summarize the data that support increased availability of whole blood for patients with life-threatening bleeding.

Recent data indicate that whole-blood transfusion is associated with improved or comparable survival compared with resuscitation with blood components. These data complement randomized controlled trials indicating that platelet-containing blood products stored at 4 °C have superior hemostatic function, compared with platelet-containing blood products at 22 °C. Whole blood is rarely available in civilian hospitals and, thus, is rarely transfused into patients with hemorrhagic shock. Misconceptions that whole blood must be ABO specific, that whole blood cannot be leukoreduced and maintain platelets, and that cold storage causes loss of platelet function have limited its availability. Understanding that these barriers are not insurmountable will improve the availability of whole blood and facilitate its use. In addition, there are logistical advantages of whole-blood-based resuscitation, as compared with component therapy, for hemorrhagic shock.

Low titer Group O whole blood stored for up to 21 days at 4 °C merits further study to compare its efficacy and safety with current resuscitation approaches for patients with life-threatening bleeding.