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Blood Transfusion and Agglutination02:45

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Whole-Blood vs Component Therapy in Adult Trauma: An Updated Systematic Review and Meta-Analysis.

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Whole-blood transfusion significantly reduced mortality in civilian trauma patients compared to component therapy. However, no significant benefit was observed in military settings, indicating a need for tailored transfusion protocols.

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Area of Science:

  • Trauma care and resuscitation science.
  • Blood transfusion medicine.
  • Evidence-based medicine and systematic reviews.

Background:

  • Hemorrhage is a leading cause of preventable trauma death.
  • The comparative effectiveness of whole-blood versus component therapy in trauma resuscitation is not well-established.
  • Heterogeneity in patient populations and resuscitation protocols complicates treatment decisions.

Purpose of the Study:

  • To determine if whole-blood transfusion reduces mortality in adult trauma patients compared to component therapy.
  • To analyze outcomes separately for civilian and military settings.
  • To provide an updated meta-analysis incorporating recent evidence.

Main Methods:

  • Systematic review and meta-analysis of randomized clinical trials and observational studies (January 2006 - June 2025).
  • Included adults (≥16 years) with traumatic hemorrhage comparing whole-blood vs. component therapy.
  • Assessed risk of bias using ROBINS-I and Cochrane RoB 2 tools.
  • Employed random-effects meta-analysis with Hartung-Knapp adjustment.

Main Results:

  • Forty studies (49,776 patients) were analyzed.
  • Whole-blood transfusion was associated with reduced 24-hour mortality (OR, 0.76) in civilian trauma patients.
  • No significant mortality benefit was observed in military trauma patients (OR, 0.99).
  • Civilians also showed reduced 30-day mortality and transfusion requirements.

Conclusions:

  • Whole-blood transfusion is associated with reduced mortality in civilian adult trauma patients.
  • Benefits were not observed in military settings, suggesting context-specific effectiveness.
  • Findings support selective whole-blood transfusion protocols in civilian centers and refined patient selection criteria.