In Vitro Evaluation of Whole Blood Hemostatic Function at a Level 1 Trauma Center

Cold-stored whole blood (CSWB) is increasingly used in civilian trauma care, but concerns remain regarding its hemostatic efficacy, particularly platelet function. This study aimed to evaluate the thromboelastogram (TEG) profiles of emergency-release whole blood units available in the blood bank of our Level 1 trauma center. We hypothesized that CSWB would show a storage age-dependent decline in platelet function and that its hemostatic profile would resemble that of reconstituted whole blood (RWB).

TEG 6S analyses were performed on samples from 10 CSWB and 10 RWB units. Parameters assessed included reaction time (R time), functional fibrinogen (FF), and maximum amplitude (MA). Results were compared between groups and analyzed relative to storage age.

R times were within normal limits for all samples. For FF, 2/10 CSWB samples were below normal compared to none of the RWB samples (P = 0.474). For MA, 7/10 CSWB samples were below normal compared to none of the RWB samples (P = 0.003). All RWB MA values exceeded those of CSWB. No correlation was found between CSWB MA values and storage age.

In vitro platelet function, as assessed by TEG 6S, was below normal in most CSWB units but normal in all RWB samples. These findings suggest that transfusing hemostatically deficient CSWB may be suboptimal in managing trauma-related coagulopathy.