Whole Blood for the Resuscitation of Massively Bleeding Civilian Patients

The use of whole blood for the resuscitation of trauma patients is not a new concept, but it is currently experiencing a renaissance given the modern appreciation for the need for balanced resuscitation and the survival benefits of the early intervention of blood products. When used in an uncrossmatched manner, the whole blood must be group O and have low titer anti-A and anti-B; this is known as low-titer group O whole blood (LTOWB). The serological safety of using LTOWB in the civilian setting has been demonstrated, although institutions can determine the maximum number of units to administer to a massively hemorrhaging patient. Unresolved questions surrounding the use of LTOWB include for how long the platelets are active during cold storage, whether leukoreduction affects platelet function, and a titer threshold that optimizes patient safety and LTOWB inventory management.