The whole is greater than the sum of its parts: Hemostatic profiles of whole blood variants

Lucy Z. Kornblith, Benjamin M. Howard, Christopher K. Cheung, Yelena Dayter, Suchitra Pandey, Michael P. Busch, Shibani Pati, Rachael A. Callcut, Ryan F. Vilardi, Brittney J. Redick, Mary F. Nelson, Mitchell Jay Cohen

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Mounting evidence highlighting the benefits of hemostatic resuscitation has led to a renewed interest in whole blood (WB) and reconstitutedWB(RWB). However, few data exist to characterize the clotting profiles of these variants. This study characterizes banked WBvariants and RWB in standard 1:1:1 and 2:1:1 transfusion ratios of packed red blood cells, fresh frozen plasma, and platelets (PLTs). We hypothesized that the global hemostatic profile of 1:1:1 RWB is superior to 2:1:1 RWB and that PLT-modified WB (MWB) is superior to 1:1:1 RWB.

Methods: Twenty-three units of packed red blood cells, fresh frozen plasma, and PLTswere obtained from the regional blood collection center and mixed to create 23 1:1:1 and 23 2:1:1 RWB units. Freshly donated WB units were obtained and used to create 11 of each nonmodified WB(NMWB) (room temperature and cooled) andMWB(room temperature and cooled) variants. International normalized ratio (INR)/ partial thromboplastin time (PTT), complete blood cell count, functional studies, and an extensive panel of procoagulant and anticoagulant factor assays were performed on all products.

Results: The 1:1:1 RWB had significantly lower INR and PTT (1.31 vs. 1.55, p = 0.0029; 42 seconds vs. 50 seconds, p = 0.0008) and higher activity of factors II, V, VII, VIII, IX, and X; antithrombin III, as well as protein C and higher fibrinogen levels than did 2:1:1 RWB (factor IX, 86% vs. 70%, p = 0.0313; fibrinogen, 242 mg/dL vs. 202 mg/dL, p = 0.0385). Therewere no differences in INR/PTTor factor activity between MWB and NMWB. However, MWB had greater maximum clot firmness (MCF) by rotational thromboelastometry tissue factorYactivated extrinsic clotting cascade measures than did NMWB (MCF, 61 mm vs. 50 mm, p = 0.0031). MWB also had greater MCF by rotational thromboelastometry tissue factorYactivated extrinsic clotting cascade measures than did 1:1:1 RWB (MCF, 61 mm vs. 45 mm, p = 0.0005).

Conclusion: Although 1:1:1 RWB had a superior clotting profile relative to 2:1:1 RWB,MWBexhibited even better global hemostasis than did 1:1:1 RWB. Characterization of factor-level and functional clotting differences between WB variants is imperative for understanding the clinical benefits of hemostatic resuscitation.

Original languageEnglish (US)
Pages (from-to)818-827
Number of pages10
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number6
DOIs
StatePublished - Dec 11 2014
Externally publishedYes

Keywords

  • Characterization
  • Reconstituted whole blood
  • Whole blood

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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