What's so great about whole blood? (Review)

A whole lot, observationally speaking, but RCTs are scarce

For much of the 20th century, blood transfusion meant whole blood transfusion, which was the standard both for replenishing ordinary anemia and as resuscitation for hemorrhagic shock.

There was no safety or efficacy reason why whole blood transfusion faded away. Rather, as technological and logistical advancements in the 1960s allowed for the efficient separation, storage, transport, and transfusion of the various components of whole blood (red cells, plasma, and platelets), transfusing components simply became the default.

Type-O whole blood (lacking AB antigens, a.k.a. “universal donor” blood) has continued to be used in emergencies, i.e., massive hemorrhages from trauma and gastrointestinal bleeding, with a large body of observational cohort data suggesting it might have advantages over component transfusions.

Recent research has focused on the use of so-called low-titer type O whole blood, which has minimal amounts of A and B antigen in its included plasma. This reduces the risk of transfusion reactions in recipients with blood types A, B, or AB.

Type-matched whole blood has also been extensively used in forward-deployed combat military units, particularly by the U.S. in Afghanistan.

Why Transfuse Whole Blood?

Whole blood is considered to be inherently more physiologic than blood components.

Transfusing whole blood seems to neatly solve the cumbersome ratio-calculating pertaining to massive transfusion of blood components (e.g., RBC:plasma:platelets). It can also be easier logistically and operationally.

Clotting factors are transfused in the same solution with red cells (not sequentially), theoretically enhancing coagulation.

Whole blood may maintain better oncotic properties, which could enhance resuscitation and perfusion for patients in shock.

Evidence for Whole Blood Transfusion in Hemorrhage

Excitement about whole blood transfusion originated from military experience.