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Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital.
Crit Care Med. 2007 Nov; 35(11):2576-81.CC

Abstract

OBJECTIVE

Fresh whole blood (FWB) and red blood cells (RBCs) are transfused to injured casualties in combat support hospitals. We evaluated the risks of FWB and RBCs transfused to combat-related casualties.

DESIGN

Retrospective chart review.

SETTING

Deployed U.S. Army combat support hospitals.

SUBJECTS

Donors of FWB and recipients of FWB and RBCs.

MEASUREMENTS AND RESULTS

The storage age of RBCs at transfusion was measured as an indicator of overall risk associated with the storage lesion of RBCs between January 2004 and December 2004 at one combat support hospital. Between April 2004 and December 2004, FWB was prescreened only at one combat support hospital for human immunodeficiency virus, hepatitis C virus, and hepatitis B surface antigen before transfusion. To estimate the general incidence of infectious agent contamination in FWB units, samples collected between May 2003 and February 2006 were tested retrospectively for human immunodeficiency virus, hepatitis B surface antigen, hepatitis C virus, and human lymphotropic virus. Results were compared between FWB samples prescreened and not prescreened for infectious agents before transfusion. At one combat support hospital in 2004, 87 patients were transfused 545 units of FWB and 685 patients were transfused 5,294 units of RBCs with a mean age at transfusion of 33 days (+/- 6 days). Retrospective testing of 2,831 samples from FWB donor units transfused in Iraq and Afghanistan between May 2003 and February 2006 indicated that three of 2,831 (0.11%) were positive for hepatitis C virus recombinant immunoblot assay, two of 2,831 (0.07%) were positive for human lymphotropic virus enzyme immunoassay, and none of 2,831 were positive for both human immunodeficiency virus 1/2 and hepatitis B surface antigen by Western blot and neutralization methods, respectively. The differences in the incidence of hepatitis C virus contamination of FWB donor units between those prescreened for hepatitis C virus (zero of 406; 0%) and not prescreened (three of 2,425; 0.12%) were not significant (p = .48).

CONCLUSIONS

The risk of infectious disease transmission with FWB transfusion can be minimized by rapid screening tests before transfusion. Because of the potential adverse outcomes of transfusing RBCs of increased storage age to combat-related trauma patients, the risks and benefits of FWB transfusions must be balanced with those of transfusing old RBCs in patients with life-threatening traumatic injuries.

Authors+Show Affiliations

U.S. Army Institute of Surgical Research, San Antonio, TX, USA. pspinella@ccmckids.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

17828033

Citation

Spinella, Philip C., et al. "Risks Associated With Fresh Whole Blood and Red Blood Cell Transfusions in a Combat Support Hospital." Critical Care Medicine, vol. 35, no. 11, 2007, pp. 2576-81.
Spinella PC, Perkins JG, Grathwohl KW, et al. Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. Crit Care Med. 2007;35(11):2576-81.
Spinella, P. C., Perkins, J. G., Grathwohl, K. W., Repine, T., Beekley, A. C., Sebesta, J., Jenkins, D., Azarow, K., & Holcomb, J. B. (2007). Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. Critical Care Medicine, 35(11), 2576-81.
Spinella PC, et al. Risks Associated With Fresh Whole Blood and Red Blood Cell Transfusions in a Combat Support Hospital. Crit Care Med. 2007;35(11):2576-81. PubMed PMID: 17828033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. AU - Spinella,Philip C, AU - Perkins,Jeremy G, AU - Grathwohl,Kurt W, AU - Repine,Thomas, AU - Beekley,Alec C, AU - Sebesta,James, AU - Jenkins,Donald, AU - Azarow,Kenneth, AU - Holcomb,John B, AU - ,, PY - 2007/9/11/pubmed PY - 2008/2/19/medline PY - 2007/9/11/entrez SP - 2576 EP - 81 JF - Critical care medicine JO - Crit Care Med VL - 35 IS - 11 N2 - OBJECTIVE: Fresh whole blood (FWB) and red blood cells (RBCs) are transfused to injured casualties in combat support hospitals. We evaluated the risks of FWB and RBCs transfused to combat-related casualties. DESIGN: Retrospective chart review. SETTING: Deployed U.S. Army combat support hospitals. SUBJECTS: Donors of FWB and recipients of FWB and RBCs. MEASUREMENTS AND RESULTS: The storage age of RBCs at transfusion was measured as an indicator of overall risk associated with the storage lesion of RBCs between January 2004 and December 2004 at one combat support hospital. Between April 2004 and December 2004, FWB was prescreened only at one combat support hospital for human immunodeficiency virus, hepatitis C virus, and hepatitis B surface antigen before transfusion. To estimate the general incidence of infectious agent contamination in FWB units, samples collected between May 2003 and February 2006 were tested retrospectively for human immunodeficiency virus, hepatitis B surface antigen, hepatitis C virus, and human lymphotropic virus. Results were compared between FWB samples prescreened and not prescreened for infectious agents before transfusion. At one combat support hospital in 2004, 87 patients were transfused 545 units of FWB and 685 patients were transfused 5,294 units of RBCs with a mean age at transfusion of 33 days (+/- 6 days). Retrospective testing of 2,831 samples from FWB donor units transfused in Iraq and Afghanistan between May 2003 and February 2006 indicated that three of 2,831 (0.11%) were positive for hepatitis C virus recombinant immunoblot assay, two of 2,831 (0.07%) were positive for human lymphotropic virus enzyme immunoassay, and none of 2,831 were positive for both human immunodeficiency virus 1/2 and hepatitis B surface antigen by Western blot and neutralization methods, respectively. The differences in the incidence of hepatitis C virus contamination of FWB donor units between those prescreened for hepatitis C virus (zero of 406; 0%) and not prescreened (three of 2,425; 0.12%) were not significant (p = .48). CONCLUSIONS: The risk of infectious disease transmission with FWB transfusion can be minimized by rapid screening tests before transfusion. Because of the potential adverse outcomes of transfusing RBCs of increased storage age to combat-related trauma patients, the risks and benefits of FWB transfusions must be balanced with those of transfusing old RBCs in patients with life-threatening traumatic injuries. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17828033/Risks_associated_with_fresh_whole_blood_and_red_blood_cell_transfusions_in_a_combat_support_hospital_ L2 - https://dx.doi.org/10.1097/01.CCM.0000285996.65226.A9 DB - PRIME DP - Unbound Medicine ER -