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Transfusion Service - Trauma and Massive Transfusion Practices

(P-TS-62) Impact of Low Titer O Whole Blood Implementation on Blood Component Utilization in Trauma Patients Requiring Massive Transfusion Protocol

Sunday, October 26, 2025
12:00 PM - 1:00 PM  PT
Background/Case Studies: The adoption of low titer O whole blood (LTOWB) has increasingly become accepted within trauma management protocols. At our level I trauma center, a LTOWB policy was instituted in March 2020, with systematic reporting of its usage in trauma cases beginning in 2022. CPD LTOWB units are received from the supplier with a 21-day shelf life. We hypothesized that incorporating LTOWB during massive transfusion protocol (MTP) activations would enhance blood inventory management and potentially decrease component utilization overall.

Study

Design/Methods: Transfusion data were sourced from the hospital's Blood Utilization Review Reports and monthly Transfusion Services Trauma Reports spanning 2022-2024. Data encompassed trauma MTP activations, LTOWB administration, and total packed red cell (pRBC) utilization. Comparative analysis was conducted against the 2019 baseline, prior to LTOWB implementation.

Results/Findings: The number of trauma cases necessitating MTP activation showed a yearly decline (64 cases in 2022, 55 cases in 2023, 50 cases in 2024). The administration of LTOWB within the trauma MTP cohort varied (70.3% in 2022, 47.3% in 2023, 56.0% in 2024). Total LTOWB utilization across all MTP activations demonstrated fluctuations (116 units in 2022, 99 units in 2023, 118 units in 2024). Importantly, overall institutional pRBC transfusions decreased compared to the pre-LTOWB baseline of 11,850 units in 2019 to figures of 10,025 units in 2022, 9,060 units in 2023, and 9,432 units in 2024, indicating a sustained reduction of approximately 15-23%.

Conclusions: The implementation of LTOWB in trauma resuscitations coincided with a substantial decrease in overall pRBC utilization compared to pre-LTOWB practices. However, the cost-benefit analysis remains complex due to concurrent price increases for both LTOWB ($70.57 increase) and leukoreduced pRBCs ($44.88 increase) during the study period. Additional research examining specific wastage metrics and patient outcomes is warranted to comprehensively evaluate the impact of this resuscitation strategy.