Page 26 - JSOM Fall 2019

Risk Associated With Autologous Fresh Whole Blood Training

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Benjamin P. Donham, MD *; George A. Barbee, DSc, EM PA-C ; Travis G. Deaton, MD ;
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Win Kerr, ATP, NREMT-P ; Russell P. Wier, DO ; Andrew D. Fisher, MPAS, PA-C, LP 6

ABSTRACT
Fresh whole blood (FWB) is increasingly being recognized as FWB from a walking blood bank has increased in importance
the ideal resuscitative fluid for hemorrhagic shock. Because of with US military Servicemembers frequently serving in areas
this, military units are working to establish the capability to far removed from traditional blood bank services and with
give FWB from a walking blood bank donor in environments the increasing emphasis on training for a near peer conflict.
that are unsupported by conventional blood bank services. This capability will decrease risk to the force and extend op-
Therefore, many military units are performing autologous erational reach.
blood transfusion training. In this training, a volunteer has a
unit of blood collected and then transfused back into the same Training
donor. The authors report their experience performing an es-
timated 3408 autologous transfusions in training and report As part of establishing the infrastructure to support giving
no instances of hemolytic transfusion reactions or other major FWB near the POI or in the prolonged field care/near-peer
complications. With appropriate control measures in place, environments, many units have identified the requirement to
autologous FWB training is low-risk training. train on the technical skill of collecting and transfusing FWB.
The technical skill of collecting and transfusing FWB requires
Keywords: military personnel; blood transfusion, autologous; frequent training given the skill is perishable and difficult to
simulation training simulate. Unfortunately, enlisted medical personnel and even
providers frequently have limited ability to gain experience
with FWB transfusions while working clinically at military
treatment facilities. In an effort to close this capability gap,
Introduction
many units are using autologous blood transfusion training
Currently, recommendations by both the Committee on Tac- to gain competency in FWB collection and donation. During
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tical Combat Casualty Care and the Joint Trauma System autologous FWB training, a volunteer has a unit of blood col-
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state that FWB is the ideal resuscitative fluid for hemorrhagic lected and then transfused back into the same donor.
shock. Given that hemorrhage (exsanguination) continues to
be the leading cause of potentially survivable death on the bat- In the hospital setting, transfusion of allogenic (nonautol-
tlefield and that there is mounting evidence that demonstrate ogous) blood is considered a high-risk event given that the
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that delays in blood transfusion are associated with increased transfusion of even small amounts of incompatible blood
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mortality, there has been an increased emphasis to give FWB products can be rapidly fatal. However, experts suggest that
closer to the point of injury (POI). The 75th Ranger Regi- autologous FWB transfusion in a hospital setting is low risk. 7
ment implemented of the Ranger O Low Titer (ROLO) Whole Nonetheless, there is a perception by some that autologous
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Blood Program in 2015. As part of this program, all soldiers FWB transfusion performed in a training environment is high
are screened before deployment to identify individuals who risk. Many perceive the risk of autologous blood transfusion
are type O with an IgM anti-A/B titer <1:256 and also negative training in a controlled environment to be equivalent to the
for transmission transmissible diseases. Soldiers who pass all risk associated with hospital-based allogenic (nonautologous)
these screening tests are identified as universal FWB “ROLO blood transfusions frequently performed in chaotic clinical
donors” and are thus able to serve as a battlefield walking environments. The authors are aware of several instances
blood bank. This program was recently recognized by the where FWB training was canceled or not approved due to
Army Materiel Command as the individual military winner of the perception that it is high risk. Unfortunately, there are
the annual Army’s Greatest Innovation Award. Subsequently, no data in the literature of which the authors are aware that
there has been great interest to expand FWB capability to ad- quantify the risks associated with autologous blood transfu-
ditional US military units. Given this, XVIII Airborne and III sion in a training environment. Because of this, the authors
Corps are currently working to establish this capability within felt compelled to publish their experience during autologous
their subordinate units. Additionally, the capability to give FWB training.
*Correspondence to ben.donham@JSOMonline.org
1 MAJ Donham is director of Operational Medicine, Department of Emergency Medicine Carl R. Darnall Army Medical Center, Fort Hood, TX.
2 LTC Barbee is deputy surgeon for Task Force Dragon/deputy surgeon for Clinical Operations, XVIII Airborne Corps, Fort Bragg, NC. CDR
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Deaton is chair of the Department of Emergency Medicine, Naval Medical Center, San Diego, CA. Mr Kerr is with the Special Warfare Medical
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Group (Airborne), Ft Bragg, NC. LCDR Wier is battalion surgeon and program manager, Valkyrie Emergency Blood Transfusion Training Pro-
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gram, 2d Battalion, 5th Marines, Camp Pendleton, CA. MAJ Fisher is with the Medical Command, Texas Army National Guard, Austin, TX,
and at Texas A&M College of Medicine, Temple, TX.
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