Milford Elissa M, Gurney Jennifer M, Beckett Andrew, Strandenes Geir, Reade Michael C
From the 2nd Health Brigade (E.M.M.), Australian Army, Victoria Barracks, Sydney, New South Wales; Medical School and Royal Brisbane and Women's Hospital (E.M.M. and M.C.R.), Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Joint Trauma System (J.M.G.), Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (J.M.G.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Canadian Forces Health Services (A.B.), Ottawa, Ontario, Canada; Department of Surgery (A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Immunology and Transfusion Medicine (G.S.), Haukeland University Hospital, Bergen; Medical Services (G.S.), Norwegian Armed Forces, Sessvollmoen, Norway; and Joint Health Command (M.C.R.), Campbell Park Offices, Canberra, Australian Capital Territory, Australia.
J Trauma Acute Care Surg. 2024 Sep 1;97(3):e23-e27. doi: 10.1097/TA.0000000000004369. Epub 2024 May 20.
Whole blood can be ABO-type specific (type-specific whole blood (TSWB)) or low-titer O universal donor (low-titer O whole blood (LTOWB)). Having previously used LTOWB, the US Armed Forces Blood Program began using TSWB in 1965 as a method of increasing the donor pool. In contrast to military practice, the Association for the Advancement of Blood and Biotherapies formerly the American association of blood banks (AABB), from its first guidelines in 1958 until 2018, permitted only TSWB. Attempting to reduce time to transfusion, the US military reintroduced LTOWB in the deployed environment in 2015; this practice was endorsed by the AABB in 2018 and is progressively being implemented by military and civilian providers worldwide. Low-titer O whole blood is the only practical solution prehospital. However, there are several reasons to retain the option of TSWB in hospitals with a laboratory. These include (1) as-yet ill-defined risks of immunological complications from ABO-incompatible plasma (even when this has low titers of anti-A and -B), (2) risks of high volumes of LTOWB including published historical advice (based on clinical experience) not to transfuse type-specific blood for 2 to 3 weeks following a substantial LTOWB transfusion, (3) uncertainty as to the optimal definition of "low titer," and (4) expanding the potential donor pool by allowing type-specific transfusion. Several large randomized controlled trials currently underway are comparing LTOWB with component therapy, but none address the question of LTOWB versus TSWB. There are sufficient data to suggest that the additional risks of transfusing LTOWB to non-group O recipients should be avoided by using TSWB as soon as possible. Combined with the advantage of maintaining an adequate supply of blood products in times of high demand, this suggests that retaining TSWB within the civilian and military blood supply system is desirable. TSWB should be preferred when patient blood group is confirmed in facilities with a hematology laboratory, with LTOWB reserved for patients whose blood group is unknown.
全血可以是ABO血型特异性的（血型特异性全血（TSWB））或低滴度O型通用供体（低滴度O型全血（LTOWB））。美国军队血液计划此前一直使用LTOWB，1965年开始使用TSWB，以增加献血者群体。与军事实践不同，血液与生物疗法促进协会（前身为美国血库协会（AABB））从1958年的第一版指南到2018年，只允许使用TSWB。为了缩短输血时间，美国军方于2015年在部署环境中重新引入了LTOWB；这种做法在2018年得到了AABB的认可，并且正在被全球的军事和民用供血机构逐步采用。低滴度O型全血是院前唯一可行的解决方案。然而，在有实验室的医院保留TSWB选项有几个原因。这些原因包括：（1）ABO血型不相容血浆（即使其抗A和抗B滴度较低）引起的免疫并发症风险尚不明确；（2）大量输注LTOWB的风险，包括已发表的基于临床经验的历史建议，即在大量输注LTOWB后的2至3周内不输注血型特异性血液；（3）“低滴度”的最佳定义尚不确定；（4）通过允许血型特异性输血来扩大潜在献血者群体。目前正在进行的几项大型随机对照试验正在比较LTOWB与成分输血疗法，但没有一项试验涉及LTOWB与TSWB的问题。有足够的数据表明，应尽快使用TSWB，以避免向非O型血受血者输注LTOWB带来的额外风险。再加上在高需求时期保持充足血液制品供应这一优势，这表明在民用和军事血液供应系统中保留TSWB是可取的。在有血液学实验室的机构中确认患者血型后，应优先选择TSWB，而LTOWB则保留给血型未知的患者。
