Implementation of a whole blood programme within a blood service: Practical guidance for blood providers

Early balanced transfusion is recommended for resuscitation of patients with severe bleeding. Whole blood (WB) is reintroduced as a feasible alternative to blood components, as it includes red blood cells, plasma and platelets in a physiological ratio.

In this review, we aim to provide practical guidance and a framework for blood providers aiming to implement a WB programme. The review summarizes recommendations and practical implications identified from published literature, regulatory requirements and current programmes.

WB donors are selected based on national donor selection criteria. When the patients' ABO-type is unknown, low titre anti-A and anti-B group-O WB (LTOWB) are recommended. ABO-group type-specific blood can be used in patients with known ABO type. Anticoagulants include CPD and CPDA-1. Leukoreduction can be performed with a platelet-sparing filter. WB is stored at +2 to -6°C for up to 35 days. Rotation of the stock and re-manufacturing to red cell concentrates minimizes outdating. The EDQM Guide to the preparation, use and quality assurance of blood components provides the minimum requirements. Post-implementation follow-up includes haemovigilance and quality surveillance. End users should be involved in the development of the programme and training of personnel. Emergency collection of WB can enable transfusion to patients in remote areas, during disasters and during war.

We conclude that implementation of a WB programme for routine and emergency management of patients with severe bleeding can be performed in a structured, safe and sustainable way.