Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital

Philip C. Spinella, Jeremy G. Perkins, Kurt W. Grathwohl, Thomas Repine, Alec C. Beekley, James Sebesta, Donald Jenkins, Kenneth Azarow, John B. Holcomb, Jack Chiles, Lorne Blackbourne, Dennis Nichols, Jennifer Greco, Cynthia Clagett, Gregory Thibault

Research output: Contribution to journalArticle

93 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2576-2581
Number of pages6
JournalCritical Care Medicine
Volume35
Issue number11
DOIs
StatePublished - Nov 2007
Externally publishedYes

Fingerprint

Erythrocyte Transfusion
Erythrocytes
Hepacivirus
Hepatitis B Surface Antigens
Blood Donors
Blood Transfusion
HIV
Viruses
Afghanistan
Iraq
HIV-2
Infectious Disease Transmission
Incidence
Wounds and Injuries
Immunoenzyme Techniques
HIV-1
Western Blotting
Tissue Donors

Keywords

  • Coagulopathy
  • Hemorrhage
  • Transfusion
  • Trauma
  • War
  • Whole blood

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Spinella, P. C., Perkins, J. G., Grathwohl, K. W., Repine, T., Beekley, A. C., Sebesta, J., ... Thibault, G. (2007). Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. Critical Care Medicine, 35(11), 2576-2581. https://doi.org/10.1097/01.CCM.0000285996.65226.A9

Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. / Spinella, Philip C.; Perkins, Jeremy G.; Grathwohl, Kurt W.; Repine, Thomas; Beekley, Alec C.; Sebesta, James; Jenkins, Donald; Azarow, Kenneth; Holcomb, John B.; Chiles, Jack; Blackbourne, Lorne; Nichols, Dennis; Greco, Jennifer; Clagett, Cynthia; Thibault, Gregory.

In: Critical Care Medicine, Vol. 35, No. 11, 11.2007, p. 2576-2581.

Research output: Contribution to journalArticle

Spinella, PC, Perkins, JG, Grathwohl, KW, Repine, T, Beekley, AC, Sebesta, J, Jenkins, D, Azarow, K, Holcomb, JB, Chiles, J, Blackbourne, L, Nichols, D, Greco, J, Clagett, C & Thibault, G 2007, 'Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital', Critical Care Medicine, vol. 35, no. 11, pp. 2576-2581. https://doi.org/10.1097/01.CCM.0000285996.65226.A9
Spinella, Philip C. ; Perkins, Jeremy G. ; Grathwohl, Kurt W. ; Repine, Thomas ; Beekley, Alec C. ; Sebesta, James ; Jenkins, Donald ; Azarow, Kenneth ; Holcomb, John B. ; Chiles, Jack ; Blackbourne, Lorne ; Nichols, Dennis ; Greco, Jennifer ; Clagett, Cynthia ; Thibault, Gregory. / Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. In: Critical Care Medicine. 2007 ; Vol. 35, No. 11. pp. 2576-2581.
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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.",
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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 - Chiles, Jack

AU - Blackbourne, Lorne

AU - Nichols, Dennis

AU - Greco, Jennifer

AU - Clagett, Cynthia

AU - Thibault, Gregory

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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.

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KW - Coagulopathy

KW - Hemorrhage

KW - Transfusion

KW - Trauma

KW - War

KW - Whole blood

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