Page 113 - ATP-P 11th Ed

e. Rh– (negative) females with childbearing potential must be given priority for Rh–
(negative) blood to avoid the risk of Rh sensitization.
f. Low titer blood should be used first. There is no universally accepted titer level for
a unit to be considered “low titer.” There are two methods of determining titer lev- SECTION 1
els; the indirect antiglobulin technique (IgG) and the saline technique (IgM). Based
on safe historical use and other precedents, levels of IgG<400, and IgM<100 have
been used successfully. USSOCOM recommends a titer level of <IgM256. 46
36
g. “Type O” non-titered whole blood may be used in extremis circumstances. The con-
sequences of infusing a unit of possibly high titer fresh whole blood far outweigh the
risk of patient death if a transfusion is not performed. 35,36,46
h. Donors should not be consangenous to the recipient (closely related family mem-
bers) in order to lessen the possibility of graft versus host disease. 37
i. When appropriate, set up a “walking blood bank” with pre-screened donors prior to
deployment.
j. The single most important way of protecting the patient and donor is to conduct
a thorough donor interview for infectious disease risk factors, determination and
qualification of the heath of the donor on the day of donation (see Enclosure #1:
Donor Questionnaire).
k. Donor should preferably be U.S. military.
l. The safest donor candidate is one with recent laboratory confirmation of blood
group/type and no evidence of transfusion transmissible disease. Prior blood donors
are preferred.
m. Females who have been pregnant in the past, even if they did not reach full term
should only be used as a last resort because of the increased risk of Transfusion
Related Acute Lung Injury (TRALI) (1 in 10,000–60,000).
n. Personnel who have received blood transfusions in the past should only be used as a
last resort because of the increased risk of a transfusion reaction.
o. It is highly recommended, to perform rapid, on-site viral marker screening tests of po-
tential blood donors using screening immunoassays for infectious diseases (e.g., HIV,
HBsAg, HCV) before blood is transfused. If testing is not possible prior to transfusion,
rapid, on-site viral marker testing should be performed as soon as possible and the
results recorded appropriately. NSNs for rapid viral marker screening assays are listed
in suggested packing list (See Enclosure #2: Suggested Packing List).
p. Retrospective testing for infectious disease markers will be performed on all donor
specimens. This testing will be completed at an FDA-approved, DoD laboratory
IAW FDA/AABB standards.
q. The donor should report to the nearest MTF capable of performing blood sample
collection and processing IAW the applicable theater.

102 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 103