Related Experiment Video
Updated: Jun 13, 2025
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Whole blood to total transfusion volume ratio in injured children: A national database analysis
Insiyah Campwala1, Ander Dorken-Gallastegi, Philip C Spinella
1From the Department of Surgery (I.C., A.D.-G., P.C.S., J.B.B., C.M.L.) and Department of Critical Care Medicine (P.C.S., J.B.B., C.M.L.), Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, PA.
Insights
Whole blood (WB) resuscitation in pediatric trauma patients significantly reduces mortality. Higher ratios of whole blood to total transfusion volume correlate with increased survival rates.
Area of Science:
- Pediatric Trauma Resuscitation
- Blood Transfusion Medicine
- Critical Care Medicine
Background:
- Whole blood (WB) resuscitation is gaining traction in trauma centers due to its safety and potential benefits over component therapy (CT).
- Limited data exists on the dose-response relationship between WB volume and overall transfusion volume (WB/TTV ratio) in pediatric patients.
Purpose of the Study:
- To evaluate the association between whole blood administration and mortality in injured children.
- To investigate the impact of the whole blood to total transfusion volume ratio (WB/TTV) on pediatric trauma patient outcomes.
Main Methods:
- Retrospective analysis of 4,323 pediatric patients (<18 years) receiving transfusions within 4 hours of arrival from a US trauma database.
- Multivariate analysis assessed the impact of WB and WB/TTV ratio on 4-hour and 24-hour mortality.
- Data sourced from the American College of Surgeons Trauma Quality Improvement Program.
Main Results:
- WB recipients were more likely to be in shock and had higher Injury Severity Scores compared to CT-only recipients.
- Any WB transfusion was associated with significantly reduced odds of 4-hour mortality (aOR 0.58) and 24-hour mortality (aOR 0.46).
- Each 10% increase in WB/TTV ratio correlated with a 9% decrease in 24-hour mortality (aOR 0.91).
Conclusions:
- Whole blood resuscitation is independently linked to reduced 24-hour mortality in pediatric trauma patients.
- Increasing the proportion of whole blood in total resuscitation volume (WB/TTV ratio) demonstrates a stepwise survival benefit.
- Findings support the use of whole blood and optimizing its ratio in pediatric trauma resuscitation protocols.
Background:
Whole blood (WB) resuscitation is increasingly common in adult trauma centers and some pediatric trauma centers, as studies have noted its safety and potential superiority to component therapy (CT). Previous analyses have evaluated WB as a binary variable (any versus none), and little is known regarding the "dose response" of WB in relation to total transfusion volume (TTV) (WB/TTV ratio).
Methods:
Injured children younger than 18 years who received any blood transfusion within 4 hours of hospital arrival across 456 US trauma centers were included from the American College of Surgeons Trauma Quality Improvement Program database. The primary outcome was 24-hour mortality, and the secondary outcome was 4-hour mortality. Multivariate analysis was used to evaluate associations between WB administration and mortality and WB/TTV ratio and mortality.
Results:
Of 4,323 pediatric patients included in final analysis, 88% (3,786) received CT only, and 12% (537) received WB with or without CT. Compared with the CT group, WB recipients were more likely to be in shock, according to pediatric age-adjusted shock index (71% vs. 60%) and had higher median (interquartile range) Injury Severity Score (26 [17-35] vs. 25 [16-24], p = 0.007). Any WB transfusion was associated with 42% decreased odds of mortality at 4 hours (adjusted odds ratio [aOR], 0.58 [95% confidence interval, 0.35-0.97]; p = 0.038) and 54% decreased odds of mortality at 24 hours (aOR, 0.46 [0.33-0.66]; p < 0.001). Each 10% increase in WB/TTV ratio was associated with a 9% decrease in 24-hour mortality (aOR, 0.91 [0.85-0.97]; p = 0.006). Subgroup analyses for age younger than 14 years and receipt of massive transfusion (>40 mL/kg) also showed statistically significant survival benefit for 24-hour mortality.
Conclusion:
In this retrospective American College of Surgeons Trauma Quality Improvement Program analysis, use of WB was independently associated with reduced 24-hour mortality in children; further, higher proportions of WB used over the total resuscitation (WB/TTV ratio) were associated with a stepwise increase in survival.
Level Of Evidence:
Therapeutic/Care Management; Level III.
Related Concept Videos
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:15Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...
01:22Composition of Blood
Formed elements constitute the remaining 45% of the blood volume. These...
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...
01:26Characteristics and Functions of Blood
The primary function of blood is to transport oxygen and carbon dioxide between tissues and the lungs. Oxygenated blood is bright red, while oxygen-depleted blood is darker. It also carries...