USE OF UNREFRIGERATED FRESH WHOLE-BLOOD IN MASSIVE TRANSFUSION

Objective: To establish the efficacy of transfusion of fresh unrefrige rated whole blood in surgical patients with ongoing massive bleeding d espite adequate blood-component replacement therapy and adequate surgi cal haemostasis. Design: A retrospective review of patients who receiv ed fresh unrefrigerated whole-blood transfusions, noting blood usage a nd outcome. Setting: A tertiary care teaching hospital with a major ca rdiac surgical and trauma service. Patients: All patients (n=11) recei ving fresh unrefrigerated whole-blood transfusions from March 1992 to February 1995. Results: Mean blood usage in the 24 hours before the de cision to transfuse fresh unrefrigerated whole blood was 16.5 units of packed cells (range, 6-27), 17.1 units of platelets (8-32), 14.5 unit s of fresh frozen plasma (6-26) and 13.5 units of cryoprecipitate (4-3 6). After the transfusion of fresh whole blood there was an immediate and substantial reduction in the rate and volume of blood loss in all patients. This was sustained in seven patients, who had a successful o utcome; the other four patients died within 24 hours from recurrent un controllable haemorrhage. The reduction in blood usage in the 24 hours after the transfusion of fresh whole blood was statistically signific ant in the surviving patients but not in the patients who died. None o f the surviving patients showed evidence of viral seroconversion six m onths after the transfusion. Conclusions: Our study provides prelimina ry evidence that there is a role for transfusion of fresh unrefrigerat ed whole blood in surgical patients with unresponsive life-threatening haemorrhage.