WHOLE BLOOD IS SUPERIOR TO COMPONENT TRANSFUSION FOR INJURED CHILDREN: A PROPENSITY-MATCHED ANALYSIS
*Christine M. Leeper, *Mark Yazer, *Matthew D Neal, Barbara A Gaines
University of Pittsburgh Medical Center, Pittsburgh, PA
OBJECTIVE(S): Transfusion of low titer group O-negative whole blood (LTOWB) in pediatric trauma patients is feasible and safe. Effectiveness has not been evaluated.
METHODS: Injured children ≥1 years old receive up to 30 mL/kg of cold-stored, uncrossmatched LTOWB during initial hemostatic resuscitation. LTOWB recipients (2016-current) were compared to a propensity-matched cohort who received uncrossmatched red blood cells in the trauma bay (2013-2016). Matching variables included age, hypotension, traumatic brain injury, injury mechanism, and emergent surgery. Primary outcomes were time to resolution of base deficit, product volumes transfused, and incidence of coagulopathy after resuscitation.
RESULTS: 28 children who received LTOWB were matched to 28 children in the component group. The LTOWB group had more rapid resolution of base deficit (median(IQR) 2(1-2.5) hours vs 6(2-24) hours; p<0.001)(FIGURE). Post-transfusion coagulopathy was increased in component cohort vs LTOWB (International Normalized Ratio (median(IQR) 1.6(1.4-2.2) vs 1.4(1.3-1.5); p=0.01). Less plasma volume (median(IQR) = 5(0-15) mL/kg vs 11(5-35) mL/kg; p=0.04) and less platelet volume (median(IQR) = 0(0-2) vs 3(0-8); p=0.03) was administered in LTOWB group versus component group. Other clinical variables (in-hospital death, hospital length of stay (LOS), ICU LOS, and ventilator days) did not differ between groups.
CONCLUSIONS: Compared to component transfusion, LTOWB transfusion is associated with faster resolution of shock, less coagulopathy, and decreased component product transfusion. Larger cohorts are required to assess for mortality benefit given low event rate. 
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