Wake Forest School of Medicine Winston-Salem, North Carolina, United States
Background/Case Studies: There is evidence in the civilian population that resuscitation using group O low titer whole blood (WB) may provide survival benefits to traumatically injured patients. However, there is little or no information in the literature concerning the use of WB in non-trauma patients requiring resuscitation. The objective of this study was to investigate the outcome of WB in non-trauma patients presenting with hemorrhagic shock or bleeding.
Study
Design/Methods: Existing data of all adults >18 years old receiving WB transfusion either as massive transfusion or emergency release blood at our institution were reviewed from April 2018 to December 2024. Primary outcomes measured were mortality in 24 hours or 30 days and transfusion related reactions. Secondary objectives will be to report ICU LOS and ventilation days.
Results/Findings: A total of 331 non-trauma patients received WB in our cohort. Patients were stratified into 3 indication categories (GI bleed, Operative hemorrhage such as aortic repairs, coronary artery bypass grafts and nephrectomies and Non-operative hemorrhage which include OB/GYN, acute cardiovascular disease and advanced solid malignancies). The most common etiology of non-traumatic bleed was GI bleeding (43.8%, n = 145/331). 216 (65.3%) were males and 115 (34.7%) were females. The median (Q1, Q3) age was 65 (54, 73). There is a statistical significant difference in the number of WB given, 24-hour mortality, and ICU length of stay. The overall in-hospital 24-hour mortality rate in our cohort was 18.7%. Transfusion related events such as one allergic reaction and two delayed hemolytic transfusion reactions occurred in 3 patients (See Table-1).
Conclusions: This study demonstrated that the use of WB in non-trauma patients was associated with decrease in-hospital mortality. Non-trauma patients with hemorrhagic shock or bleeding could receive WB transfusions safely without any increased transfusion related adverse effects. WB should be considered an alternative in non-trauma patients requiring immediate resuscitation.
