How do I implement a whole blood program with low blood wastage?

Background: The use of low-titer O whole blood (LTOWB) is requested in the treatment of major bleeding, initially used in military medicine but now increasingly utilized in civilian prehospital care. The advantage is the administration of a balanced transfusion, red blood cells, coagulation factors, and platelets, in one bag. The challenges are the availability of LTOWB and difficulties in predicting the need in major bleeding, leading to the risk of wastage.

Methods: This study describes different logistical strategies when implementing whole blood in the Swedish civilian healthcare. The five transfusion centers producing whole blood in Sweden participated, providing experience of the production line, usage, and wastage.

Results: In Sweden, LTOWB is used prehospital in helicopter emergency medical service (HEMS), in one physician-manned rapid response vehicle, and inhospital in three University Hospitals. The logistical strategies to reduce wastage vary but involve the rotation of LTOWB not used prehospital to inhospital use in two centers and the preparation of red blood cell (RBC) units from 1 to 2 weeks old LTOWB in three centers. The number of transfused LTOWB units varies between the centers, and wastage was 0%-13% in 4/5 centers and higher in one center, 34%.

Conclusion: It is difficult to predict the need of LTOWB, requested in prehospital emergencies. Aiming for low wastage requires different logistical chains, depending on the local prerequisites. In Sweden, LTOWB is either rotated for use in major bleeding in hospital or prepared to RBC units after 1 week prehospital.