“Whole Blood? Seriously?” That is the reaction Dr. Mark Yazer gets when he talks about his current favorite blood product. He is on a mission to change your mind about this “old school” product!
In the remote history of transfusion medicine, life was simple. We had exactly one product. Someone could call and say, “hey, my patient needs red cells,” and our response: “Great, we’ve got some nice whole blood for ya!” Or, “this guy could really use some plasma.” Blood bankers: “We’ve got just the thing: Whole blood!”
However, around 50 years ago, we started separating whole blood into red cells, plasma, and platelets, and the age of “component therapy” was born. Hardly anyone used whole blood (except the military, where such use continued throughout numerous US combat campaigns).
Back to the Future
In 2017, as we learn more and more about what works and what doesn’t in trauma resuscitation, some are looking again at whole blood. Dr. Mark Yazer is helping to lead the charge toward the use of this product, specifically low-titer group O cold-stored whole blood, which he calls “the ideal pre- and early in-hospital resuscitation fluid!” In this episode, Mark returns to outline his case for that outrageous statement, making the following points (with time-stamps for where you can hear the points in the discussion):
- There is a long history of transfusing whole blood [17:48]
- It simplifies the logistics of resuscitation [25:10]
- It is more concentrated than components [29:03]
- Cold-stored platelets might be great! [33:37]
- Nobody hemolyzes! [39:48]
- Outcomes are not worse compared to component therapy [47:53]
Dr. Mark Yazer graduated from medical school at the University of Ottawa and completed his residency in hematological pathology at the University of Alberta. He is currently a professor of pathology at the University of Pittsburgh, and the medical director of the RBC serology laboratory at the centralized transfusion service in Pittsburgh, one of the largest transfusion services in North America. He is also an adjunct professor of clinical immunology at the University of Southern Denmark. Mark has published over 150 peer reviewed papers, and is an associate editor of the journal Transfusion Medicine and the journal Hematology. He is on the editorial board of 4 other journals. He is the chairman of the AABB’s molecular testing standards unit, and the co-chairman of the AABB/THOR working group. He is on the scientific advisory/speakers board of 7 corporations, and he has given more than 200 lectures on his research worldwide. His research interests include patient blood management, blood utilization in trauma, and electronic enhancements for patient safety.
This podcast episode offers a FREE continuing education activity where you can earn the following types of credit: 1 AMA PRA Category 1 CreditTM, 1 ASCLS P.A.C.E. ® Contact Hour (including Florida Clinical Laboratory Credit), and American Board of Pathology Self-Assessment Modules (SAMs) for Maintenance of Certification MOC).
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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Mark discloses honoraria from Terumo, while I have no relevant financial disclosures.
The images below are generously provided by Dr. Yazer.
- 2016 article summarizing history and current use of whole blood for resuscitation: Spinella, PC et al. Whole blood for hemostatic resuscitation of major bleeding. Transfusion 2016;56;S190–S202
- Another excellent summary of the history and current use of whole blood: Bahr MP et al. Whole blood for the acutely haemorrhaging civilian trauma patient: a novel idea or rediscovery? Transfusion Medicine 2016;26:406–414
- Evaluation for lab signs of hemolysis on a group of whole blood recipients in trauma resuscitation: Seheult JN et al. Measurement of haemolysis markers following transfusion of uncrossmatched, low-titre, group O+ whole blood in civilian trauma patients: initial experience at a level 1 trauma centre. Transf Med 2017;27:30-35
- Dr. Yazer and group’s initial report on safety data for Pittsburgh whole blood program: Yazer MH et al. Initial safety and feasibility of cold-stored uncrossmatched whole blood transfusion in civilian trauma patients. J Trauma Acute Care Surg 2017;81(1):21-25