Use of unrefrigerated fresh whole blood in massive transfusion

Objective: To establish the efficacy of transfusion of fresh unrefrigerated whole blood in surgical patients with ongoing massive bleeding despite adequate blood-component replacement therapy and adequate surgical haemostasis. Design: A retrospective review of patients who received fresh unrefrigerated whole-blood transfusions, noting blood usage and outcome. Setting: A tertiary care teaching hospital with a major cardiac surgical and trauma service. Patients: All patients (n=11) receiving fresh unrefrigerated whole-blood transfusions from March 1992 to February 1995. Results: Mean blood usage in the 24 hours before the decision 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 units of fresh frozen plasma (6-26) and 13.5 units of cryoprecipitate (4-36). 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 outcome; the other four patients died within 24 hours from recurrent uncontrollable haemorrhage. The reduction in blood usage in the 24 hours after the transfusion of fresh whole blood was statistically significant in the surviving patients but not in the patients who died. None of the surviving patients showed evidence of viral seroconversion six months after the transfusion. Conclusions: Our study provides preliminary evidence that there is a role for transfusion of fresh unrefrigerated whole blood in surgical patients with unresponsive life-threatening haemorrhage.