Low-titer O whole-blood transfusion for life-threatening gastrointestinal and post-partum hemorrhage

Low-titer O whole blood (LTOWB) is found to be associated with a survival advantage in trauma-related major hemorrhage in some prospective studies. The role of LTOWB in non-trauma patients has not been as extensively studied. In this study, we assess the feasibility and safety of administering LTOWB to patients with life-threatening gastrointestinal bleeding (GIB) and post-partum hemorrhage (PPH).

We performed a retrospective study of patients who received LTOWB at a large regional academic center for life-threatening GIB and PPH according to hospital protocol between 1 December 2023 and 31 December 2025. Demographic, clinical, transfusion, laboratory data, including hemolysis-related variables, and clinical outcomes were compared between group-O and non-group-O patients.

We studied 112 patients, 53 men and 59 women, with a median (interquartile range [IQR]) age of 68 (41-77) years. Of these, 87/112 (77%) had GIB and 25/112 (23%) had PPH; 38/112 (34%) were group-O and 74/112 (66%) non-group-O. In total, 203 LTOWB units were transfused, 155 for GIB and 48 for PPH. The median (IQR) number of LTOWB units transfused to both group-O patients and non-group-O was 2 (1-2). There were no clinically significant laboratory or mortality differences between group-O versus non-group-O patients, which was 3% versus 4% at 24 h, respectively. No hemolytic transfusion reactions were reported.

LTOWB transfusion for life-threatening GIB or PPH is feasible and not associated with hemolysis in non-group-O recipients. Further studies are required to determine the clinical utility of this transfusion strategy.