Analysis of Outcomes after Whole Blood Transfusion vs Balanced Component Therapy

Whole blood (WB) transfusion is preferred to component therapy in hemorrhaging trauma patients. However, posttrauma complications with WB transfusion vs balanced component therapy (BCT) are not well studied. We sought to determine if WB transfusion results in decreased morbidity and mortality and hypothesized that WB transfusion would yield fewer complications.

TQIP data from 2018 to 2021 were analyzed. Patients who received any volume of blood products within the first 4 hours were included. Patients younger than 18 years of age, with head or burn injuries, or missing demographic information were excluded. BCT was defined as 1:1:1 packed RBC:plasma:platelets, with only 1% difference between each component volume qualifying as balanced. Propensity matching was used to compare patients who received WB transfusion and BCT.

Before matching, there were 7,687 patients; 2,343 (30.48%) BCT and 5,344 (69.52%) WB. Post-propensity matching included 4,434 patients evenly distributed between BCT and WB groups. There were no differences in demographics between groups. The WB cohort had shorter ICU stays and significantly lower rates of acute kidney injury, acute respiratory distress syndrome, cardiac arrest, deep vein thrombosis, unplanned ICU admission, unplanned intubation, and unplanned surgery than BCT. There was no significant difference in in-hospital mortality between the 2 groups (p = 0.30).

WB transfusion was associated with fewer complications compared with BCT but did not appear to be associated with improved survival. Further studies are needed to examine the mechanism driving lower incidence of complications with WB transfusion.