Utilization patterns of low-titer group O whole blood in a level 1 trauma center

Whole blood (WB) is an easy-to-use resuscitation fluid. As more low-titer group O WB has become available at our hospital, it is being used in an increasingly diverse range of situations, both pre-hospital and in-hospital.

We conducted a retrospective analysis of all WB units issued by our transfusion service during calendar year 2024. Data were obtained from the transfusion service database and linked to patient medical records to characterize indications, location of transfusion, and patient outcomes. Results are descriptive.

A total of 1915 WB units were issued. 1879 units (98.1%) were transfused to 524 patients, of which 237 units (12.6%) were prehospital. Of these, 1817 units (96.7%) were transfused to patients ultimately treated at HMC. Trauma accounted for the majority of in-hospital utilization (87.6%), with motor vehicle collisions (MVCs) and penetrating trauma the most common indications. Non-trauma indications accounted for 12.4% of transfused units and included gastrointestinal bleeding, vascular surgery, cardiac emergencies, necrotizing soft tissue infections, and other shock states. Among 477 admitted patients who received WB, in-hospital mortality was 29.6%. Operational strategies, including extended cooler validation and retention of inventory ownership until use, supported high utilization with minimal waste.

Whole blood utilization was primarily driven by traumatic hemorrhage but extended across diverse acute care settings. Utilization patterns were shaped by supply limitations and operational considerations rather than clinical demand alone, underscoring the importance of incorporating logistics and utilization data into future whole blood research and implementation efforts.