Non-Anticoagulated Fresh Whole Blood Syringe Transfusion as an Alternative for Military Hemorrhage Resuscitation in...

Military field medicine providers often operate in resource-limited environments where improvization with available equipment is essential. Whole blood transfusion has had significant benefits in treating severely injured trauma patients in these settings. Current protocols often mandate anticoagulant-containing intravenous (IV) fluid bags for fresh whole blood transfusion, which can pose logistical challenges for forward-placed medical units. This study explores the feasibility of using a syringe without anticoagulant as an alternative method.

Whole blood was collected from healthy volunteer donors and divided into syringes with and without citrate-phosphate-dextrose (CPD) solution. Samples were stored for varying durations and infused through a standard IV setup to simulate transfusion conditions. To assess coagulation, infusion rate under standardized infusion pressure, clot mass, and coagulation parameters (PT/INR, PTT) was measured. Hemolysis was assessed by measuring plasma hemoglobin, potassium, lactate dehydrogenase (LDH), bilirubin pre- and post-infusion at either 100 mL/minute, 200 mL/minute or maximal manual compression.

We performed a nested analysis of variance (ANOVA) analysis on coagulation and hemolysis parameters. Tukey post-hoc testing was used to determine mean subgroup differences. Analyses were carried out using R version 4.3.0 (R Core Team, 2024). Significant differences were observed in infusion rates across different storage times but not between CPD and non-CPD conditions. There was significantly greater clot burden in non-CPD groups compared to CPD at 30 minutes (6.5 ± 2.1 g) and 60 minutes (8.8 ± 1.9 g), but no significant difference was observed in the 30 second (0.001 ± 2.0 g) and 5 minute (1.1 ± 2.0 g) groups. Coagulation parameters (INR, PT, and PTT) showed no significant differences based on storage time but were impacted by the presence of CPD. Hemolysis markers indicated significant changes in plasma hemoglobin with higher infusion rates but no significant alterations in LDH, potassium, or bilirubin at any of the infusion rates.

These findings suggest that non-anticoagulated fresh whole blood may be transfused within 5 minutes at infusion rates of 100 mL/minute or less with no significant clot burden and no evidence of hemolysis. Longer storage times and faster infusion rates may also be clinical safe but require further investigation. This study indicates that there may be some potential use of this method in military units executing a fresh whole blood draw with short donor-to-recipient times.