Whole Blood Is Back

Originally the only option available for transfusion therapy, whole blood transfusions fell out of widespread usage in civilian practice the United States towards the conclusion of World War II, as modern blood banking techniques emerged. With the emergence of blood banks, came the rise of component therapy, which allowed for more efficient utilization of blood products, with one unit of donated blood being able to serve several patients. However, the practice of whole blood transfusion in the military has continued, with forward surgical teams relying on it for massive transfusion scenarios in settings of limited supplies. Recent success with whole blood transfusion in the military has prompted new discussions about implication in a civilian setting, particularly in the treatment of traumatic hemorrhage. Current treatment guidelines for resuscitation of traumatic hemorrhage call for blood products to be administered in a 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets. The aim of this is to re-create whole blood as closely as possible. However, this mixture has been shown to be have a lower than anticipated hematocrit, as well as sub-optimal function of platelets and plasma coagulation factors. Whole blood delivers a product that most closely resembles what is being lost, with a higher hematocrit and better function of platelets and plasma coagulation factors. With clinical trials beginning at several major trauma centers across the United States, whole blood transfusion is poised to have a tremendous impact on the management of hemorrhage in the civilian setting that should be watched closely by anesthesiologists going forward.