Sang total de banque: Oui mais avec une logistique adhoc

The use of whole blood in US military operations in Iraq, Syria, and Afghanistan since the introduction of low-titer Type O whole blood: feasibility, acceptability, challenges.

Vanderspurt CK et Al Transfusion. 2019 Mar;59(3):965-970

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L'emploi de sang total est redevenu d'actualité, qu'il s'agisse de sang prélevé sur pied ou conservé en banque. Ce dernier est de plus en plus employé, notamment en role 2, avec cependant une difficulté qui tient à une moindre durée de conservation (21 jours en poche CPD  et 35 jours en poche CPDA-1). Réduire le délai prélèvement-délivrance sur zone est donc fondamental si l'on souhaite en tirer le meilleur bénéfice. La production sur zone de combat de ce type de produit pourrait être une solution. 

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BACKGROUND:

 

Hemorrhage is the leading cause of preventable death in military and civilian traumatic injury. Blood product resuscitation improves survival. Low-titer Type O Whole Blood (LTOWB) was recently re-introduced to the combat theater as a universal resuscitation product for hemorrhagic shock. This study assessed the utilization patterns of LTOWB compared to warm fresh whole blood (WFWB) and blood component therapy (CT) in US Military Operations in Iraq/Syria and Afghanistan known as Operation Inherent Resolve (OIR) and Operation Freedom's Sentinel (OFS) respectively. We hypothesized LTOWB utilization would increase over time given its advantages.

STUDY DESIGN AND METHODS:

 

Using the Theater Medical Data Store, patients receiving blood products between January 2016 and December 2017 were identified. Product utilization ratios (PUR) for LTOWB, WFWB, and CT were compared across Area of Operations (AORs), medical treatment facilities (Role 2 vs. Role 3), and time. PUR was defined as number of blood products transfused/(number of blood products transfused + number of blood products wasted).

RESULTS:

The overall PUR for all blood products was 17.4%; the LTOWB PUR was 14.3%. Over the study period, the total number of blood products transfused increased 133%. Although the total whole blood (WB) increased from 2.1% to 6.6% of all products transfused, WFWB use remained at 2% while LTOWB transfusions increased from 0.5% to 4%. Transfusion of LTOWB occurred more in austere Role 2 facilities compared to Role 3 hospitals.

CONCLUSIONS:

LTOWB transfusion is feasible in austere, far-forward environments. Further investigation is needed regarding the safety, clinical outcomes, and drivers of LTOWB transfusions.