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Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care.
PLoS One. 2016; 11(12):e0168401.Plos

Abstract

INTRODUCTION

The Netherlands Armed Forces use -80°C frozen red blood cells (RBCs), plasma and platelets combined with regular liquid stored RBCs, for the treatment of (military) casualties in Medical Treatment Facilities abroad. Our objective was to assess and compare the use of -80°C frozen blood products in combination with the different transfusion protocols and their effect on the outcome of trauma casualties.

MATERIALS AND METHODS

Hemovigilance and combat casualties data from Afghanistan 2006-2010 for 272 (military) trauma casualties with or without massive transfusions (MT: ≥6 RBC/24hr, N = 82 and non-MT: 1-5 RBC/24hr, N = 190) were analyzed retrospectively. In November 2007, a massive transfusion protocol (MTP; 4:3:1 RBC:Plasma:Platelets) for ATLS® class III/IV hemorrhage was introduced in military theatre. Blood product use, injury severity and mortality were assessed pre- and post-introduction of the MTP. Data were compared to civilian and military trauma studies to assess effectiveness of the frozen blood products and MTP.

RESULTS

No ABO incompatible blood products were transfused and only 1 mild transfusion reaction was observed with 3,060 transfused products. In hospital mortality decreased post-MTP for MT patients from 44% to 14% (P = 0.005) and for non-MT patients from 12.7% to 5.9% (P = 0.139). Average 24-hour RBC, plasma and platelet ratios were comparable and accompanying 24-hour mortality rates were low compared to studies that used similar numbers of liquid stored (and on site donated) blood products.

CONCLUSION

This report describes for the first time that the combination of -80°C frozen platelets, plasma and red cells is safe and at least as effective as standard blood products in the treatment of (military) trauma casualties. Frozen blood can save the lives of casualties of armed conflict without the need for in-theatre blood collection. These results may also contribute to solutions for logistic problems in civilian blood supply in remote areas.

Authors+Show Affiliations

Military Blood Bank, Ministry of Defense, Leiden, The Netherlands.Ministry of Defense and Department of Trauma, Division of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.Expert Centre Force Health Protection, Ministry of Defense, Doorn, The Netherlands.Military Blood Bank, Ministry of Defense, Leiden, The Netherlands.Transfusion Service, Harborview Medical Centre, Seattle, United States of America.Ministry of Defense and Department of Surgery, Alrijne Medical Centre Leiderdorp, Leiden University Medical Centre, Leiden, the Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27959967

Citation

Noorman, Femke, et al. "Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care." PloS One, vol. 11, no. 12, 2016, pp. e0168401.
Noorman F, van Dongen TT, Plat MJ, et al. Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care. PLoS One. 2016;11(12):e0168401.
Noorman, F., van Dongen, T. T., Plat, M. J., Badloe, J. F., Hess, J. R., & Hoencamp, R. (2016). Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care. PloS One, 11(12), e0168401. https://doi.org/10.1371/journal.pone.0168401
Noorman F, et al. Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care. PLoS One. 2016;11(12):e0168401. PubMed PMID: 27959967.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care. AU - Noorman,Femke, AU - van Dongen,Thijs T C F, AU - Plat,Marie-Christine J, AU - Badloe,John F, AU - Hess,John R, AU - Hoencamp,Rigo, Y1 - 2016/12/13/ PY - 2016/09/18/received PY - 2016/11/30/accepted PY - 2016/12/14/entrez PY - 2016/12/14/pubmed PY - 2017/7/14/medline SP - e0168401 EP - e0168401 JF - PloS one JO - PLoS One VL - 11 IS - 12 N2 - INTRODUCTION: The Netherlands Armed Forces use -80°C frozen red blood cells (RBCs), plasma and platelets combined with regular liquid stored RBCs, for the treatment of (military) casualties in Medical Treatment Facilities abroad. Our objective was to assess and compare the use of -80°C frozen blood products in combination with the different transfusion protocols and their effect on the outcome of trauma casualties. MATERIALS AND METHODS: Hemovigilance and combat casualties data from Afghanistan 2006-2010 for 272 (military) trauma casualties with or without massive transfusions (MT: ≥6 RBC/24hr, N = 82 and non-MT: 1-5 RBC/24hr, N = 190) were analyzed retrospectively. In November 2007, a massive transfusion protocol (MTP; 4:3:1 RBC:Plasma:Platelets) for ATLS® class III/IV hemorrhage was introduced in military theatre. Blood product use, injury severity and mortality were assessed pre- and post-introduction of the MTP. Data were compared to civilian and military trauma studies to assess effectiveness of the frozen blood products and MTP. RESULTS: No ABO incompatible blood products were transfused and only 1 mild transfusion reaction was observed with 3,060 transfused products. In hospital mortality decreased post-MTP for MT patients from 44% to 14% (P = 0.005) and for non-MT patients from 12.7% to 5.9% (P = 0.139). Average 24-hour RBC, plasma and platelet ratios were comparable and accompanying 24-hour mortality rates were low compared to studies that used similar numbers of liquid stored (and on site donated) blood products. CONCLUSION: This report describes for the first time that the combination of -80°C frozen platelets, plasma and red cells is safe and at least as effective as standard blood products in the treatment of (military) trauma casualties. Frozen blood can save the lives of casualties of armed conflict without the need for in-theatre blood collection. These results may also contribute to solutions for logistic problems in civilian blood supply in remote areas. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27959967/Transfusion:__80°C_Frozen_Blood_Products_Are_Safe_and_Effective_in_Military_Casualty_Care_ L2 - https://dx.plos.org/10.1371/journal.pone.0168401 DB - PRIME DP - Unbound Medicine ER -