Fresh Whole Blood Transfusion

What would you do if placed in an environment or situation in which laboratory prepared blood components such as packed red blood cells, fresh frozen plasma and platelets were unavailable when a trauma patient needed it?

Fresh whole blood transfusion (FWB) has been used for the past century by the U.S. Military while deployed in austere environments. A retrospective study from the Iraq and Afghanistan wars shows that FWB may improve survival. Although this is not with adverse effects. Renal failure was more frequent in the FWB group (8%) compared with competent therapy (3%). The increased frequency of deep vein thrombosis and acute respiratory distress syndrome also approached significance. This matches the 2.5 increase in transfusion reactions associated with whole blood transfusion reported in Roberts and Hedges. In addition, because of lack of screening, the risk of transmission of bloodborne pathogens (e.g., HIV, hepatitis B/C, syphilis) is increased. Screening for risk factors of potential donors will decrease the chance of bloodbourne pathogen transmission. Please remember that FWB is not FDA-approved and is not intended or indicated for routine use.


  1. There is not a universal donor for whole blood. Donor FWB must be an ABO type-specific match to the recipient. Reported blood types should not be trusted. Up to 11% of military ID tags have the wrong blood type. Blood typing is easily accomplished in less than 10 minutes with a blood typing card.
  2. Once a suitable donor is found, obtain blood by gravity into a commercial blood bag. The bags can hold up to 600ml. The bag should only be filled with 450ml (the bag will be firm and almost full). If a counter weight is available, the target weight for 450 mL is 585 grams. Do not overfill or under fill blood bags due to the predetermined anticoagulant/blood ratio. Label the bag with blood type and donor identification. Blood tubes should be drawn for future testing (ie infectious disease)
  3. Rapid infectious disease testing (i.e., HIV, HBV, HCV) of donor specimens should be performed if available.
  4. Blood tubes should be drawn from the recipient for testing and future blood product cross matching if it becomes available.
  5. Confirm the ABO blood type of the donor and recipient, spike the bag with filter blood tubing and start the infusion. The blood can be mixed with 250ml of normal saline to decrease the viscosity thereby increasing the infusion rate.
  6. As little FWB as possible should be used secondary to antigenic complications.
  7. FWB should be destroyed 24-hours after collection. It can be stored at room temperature for 8-hours, before needing to be refrigerated.
Roberts and Hedges, 5th Ed. Ch. 28
Bowling F, Kerr W. Fresh whole blood transfusions in the austere environment. J Spec Oper Med. 2011 Summer;11(3):3-37.
Andy, C. S. (ed.), et al. (2004). Emergency War Surgery, Third US Revision, Chapter 7: Shock and Resuscitation. p. 7.11.
Joint Theater Trauma System Clinical Practice Guideline Fresh Whole Blood Transfusion.
Spinella, P. C., Perkins, J. G., et al. (2009). Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. Journal of Trauma; 66(4 Suppl):S69-76.
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This entry was posted in Hematology, Medications, Resus, Trauma. Bookmark the permalink.

One Response to Fresh Whole Blood Transfusion

  1. Timely post, thanks Mike. I’m just doing a translation on blood transfusions in dogs and this post has come in handy for the section on fresh whole blood.

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