US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX.
Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and Uniformed Services University of the Health Sciences, Bethesda, MD.
Med J (Ft Sam Houst Tex). 2022 Apr-Jun(Per 22-04/05/06):40-45.
Introduction: During multi-domain combat operations, logistical constraints may compel forward medical personnel to decide whether to use expired blood products. The incidence of expired blood product usage in recent conflicts is unknown.
We queried the Armed Services Blood Program (ASBP) database of all blood administered in theater from 2002-2019. We categorized any administration of blood product with a transfusion date of 1-30 days after the expiration date for this analysis. We excluded any documented transfusions more than 30 days after the expiration date as likely represents clerical error based on study team experience.
There were 1,491 (0.4% of the total transfusion dataset) units that met inclusion for this analysis. Of the 1,491, 86% (n=1,278 transfusions) will occur within 1-3 days post-expiration. These 1,491 units were transfused into 741 patients. The majority of expired blood product recipients were male (87%). Afghans were most frequent (46%), followed by US forces (22%) with most occurring during Operation Enduring Freedom (64%). Trauma was the most common mechanism of injury for these patients (70%). The most common blood type transfused to recipients was O positive (28%). The most frequently transfused expired unit was red blood cells (n=899), followed by platelets (n=299), followed by whole blood (n=152).
Expired red blood cell and platelet use suggests a need for better methods for extending the lifespan of whole blood and further development of longer stability cold-stored platelets to meet the needs of our end-users. Our data arises from mature theaters during counterinsurgency operations. The incidence of transfusion of expired blood products may increase in future multi-domain operations where medical personnel are likely to operate under more resource constrained settings.
介绍：在多领域作战行动中，后勤限制可能迫使前方医务人员决定是否使用过期的血液制品。在最近的冲突中，使用过期血液制品的情况尚不清楚。
我们查询了 2002 年至 2019 年期间在战区内输注的所有血液的武装部队血液计划（ASBP）数据库。我们将输血日期在过期日期后 1-30 天内的任何血液制品的输注归类于此分析。我们排除了任何记录的输血超过过期日期 30 天的情况，因为根据研究团队的经验，这可能代表文书错误。
共有 1491 个（总输血数据集的 0.4%）单位符合此分析的纳入标准。在这 1491 个单位中，86%（n=1278 次输血）将在过期后 1-3 天内发生。这 1491 个单位被输注到 741 名患者中。过期血液制品接受者中大多数为男性（87%）。阿富汗人最为常见（46%），其次是美国军队（22%），其中大多数发生在持久自由行动（64%）期间。这些患者最常见的受伤机制是创伤（70%）。输注给接受者的最常见血型是 O 阳性（28%）。输注最多的过期单位是红细胞（n=899），其次是血小板（n=299），其次是全血（n=152）。
输注过期的红细胞和血小板表明需要更好的方法来延长全血的寿命，并进一步开发更稳定的冷藏血小板，以满足最终用户的需求。我们的数据来自成熟战区的反叛乱行动。在未来的多领域行动中，由于医务人员可能在资源更有限的环境下运作，因此使用过期血液制品的情况可能会增加。
