Low-titer O whole blood in management of massive bleeding

Abstract

The management of massively bleeding patients has undergone paradigm shift. With the evolution of bundle of care in form of damage control resuscitation, early blood-based resuscitation has emerged as one of the pillars of treatment; focused at preventing shock, coagulopathy, and thrombocytopenia. Military has always relied on low-titer O whole blood (LTOWB) to provide balanced hemostatic resuscitation for bleeding patients in combat casualties. Good results from military practice have led to questioning of practices followed in civilian bleeding trauma patients. With the realization that cold-stored platelets are functionally superior for immediate hemostasis, there is renewed interest in role of LTOWB in providing early hemostatic resuscitation to massively bleeding patients. Not only does LTOWB provide all the components but it also has an advantage of simplifying resuscitation logistics by providing all the components in one bag instead of three, in situations where delay of every minute leads to increased mortality. It can provide blood-based resuscitation in scenarios where it may not otherwise be possible. It can be used across all blood groups. This review explores the concerns regarding the use of LTOWB, historical perspective, advantages, and disadvantages. Several studies have shown that LTOWB is noninferior, as compared to components, and is a safe practice, without significant transfusion-related adverse events. The use of LTOWB in bleeding patients needs further studies to explore its efficacy and safety versus component therapy.

Keywords

• components
• damage control resuscitation
• hemorrhage
• low-titer o whole blood
• massive