The initial use of low-titer group O whole blood (LTOWB) in emergency transfusion offers no advantage over component therapy in 30 day survival or selected nonlethal adverse outcomes, according to research published in Transfusion.
Researchers conducted a retrospective, single-center study to assess whether initial use of LTOWB compared with packed red blood cells (pRBCs) reduced overall blood requirements for patients in need of emergency transfusion.
The team compared patients transfused with emergency-release, uncrossmatched pRBCs followed by component therapy between 2016 and 2019 versus patients transfused with emergency-release, uncrossmatched LTOWB followed by component therapy between 2019 and 2022 at a large US urban academic medical center. The study’s primary outcome was total blood use during the first 24 hours and first 7 days. Secondary outcomes included survival and non-lethal adverse clinical outcomes.
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The pRBC group included 602 patients (median age, 59 years; interquartile range [IQR], 41–72; 64.0% men and 36% women), and the LTOWB group included 749 patients (median age, 60; IQR, 43-72; 67% men and 33% women). The researchers reported the groups were well balanced for patient demographics and estimated blood volume, ABO blood groups, and underlying diagnosis.
The team found the initial use of LTOWB was associated with increased total blood product use at 24 hours (4.0 units [U] in pRBC group vs 6.5 U in the LTOWB group; P <.0001) and at 7 days (5.5 U in pRBC group vs 7.3 in the LTOWB group; P <.0001).
They observed no significant improvement in 24 hour or 30 day survival nor lower incidence of non-lethal adverse clinical outcomes with the initial use of LTOWB compared with that of pRBC.
“No survival benefit of LTOWB administration was observed in this civilian population of mixed bleeding etiology,” the researchers concluded in their report. Limitations of the study included the retrospective, single-center design, and potential temporal differences in the cohorts.
Reference
Ruby KN, Dzik WH, Collins JJ, Eliason K, Makar RS. Emergency transfusion with whole blood versus packed red blood cells: A study of 1400 patients. Published online February 10, 2023. Transfusion. doi:10.1111/trf.17259
