Page 27 - JSOM Fall 2019

Results Benadryl is accessible in the event there are any minor allergic
reactions to the preservative in the FWB collection bag. The
In total, the authors have conservatively performed an esti- authors recommend a 1:5 trainer:student ratio.
mated 3408 autologous blood transfusions in training and
have not experienced any instances of major or minor he- The primary feared complication of autologous FWB train-
molytic transfusion reactions. In addition, no instances of ing is major hemolytic transfusion reaction that could oc-
anaphylactic allergic reaction occurred or were there any cur if participant accidentally did not receive his own blood
complications that required an emergency department visit or during transfusion (i.e., inadvertent allogenic [nonautologous]
required follow-on care. The authors do report several minor transfusion). Although this complication would be considered
complications that include 2 instances of ocular blood expo- catastrophic by the Army’s Composite risk management, it
sure, 1 minor allergic reaction that resulted in urticaria, and is unlikely to occur and without control measures would be
14 instances where individuals had a vasovagal reaction to ve- considered medium-risk training. The other observed compli-
nipuncture unassociated with blood donation or transfusion cations the authors experienced while performing autologous
(Table 1). The FWB collection kits do include citrate as a pre- FWB training represent marginal risk and seldom occurred
servative, and the authors do report that with rapid infusion and thus are low risk. After implementation of appropriate
(pressure infused) of autologous blood there is high rate of control measures as described here, we assess the overall re-
perioral paresthesia that resolve without intervention. We re- sidual risk to be low.
alize these data suffers from significant recall bias and thus do
not contribute to generalizable knowledge. However, given the
lack of information on the topic, we believe it is important to Conclusion
discuss our experience to guide future risk assessment.
Autologous fresh whole blood training when conducted with
appropriate control measures infrequently results in complica-
TABLE 1 Complications Seen During Autologous Fresh Whole tions and is low-risk training. This training is critical to be able
Blood Training (N = 3408) to provide the capability to give FWB in far forward locations
Complication n (%) not supported by conventional blood bank such as the POI or
Vasovagal episode (syncope/near syncope) 14 (0.41) prolonged field care environments.
Ocular blood exposure 2 (0.06)
Minor allergic reaction (urticaria) 1 (0.02) Disclosure
Anaphylactic allergic reaction 0 (0) The authors have nothing to disclose.
Anaphylactic allergic reaction 0 (0)
Major hemolytic transfusion reaction 0 (0) References
1. Committee on Tactical Combat Casualty Care. Tactical Combat
Minor hemolytic transfusion reaction 0 (0)
Casualty Care Guidelines for Medical Personnel. 2018.
2. Joint Trauma System. Damage Control Resuscitation: Clincal
Although different organizations have diverse protocols for Practice Guidelines 18. 2017.
conducting autologous FWB training, there are several uni- 3. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
versal control measures in place to ensure the training is con- (2001-2011): implications for the future of combat casualty care. J
ducted safely. In order to prevent allogenic (nonautologous) Trauma Acute Care Surg. 2012;73(6 suppl 5):S431–437.
transfusion, participants are instructed to ensure that they re- 4. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Associa-
ceive only their own blood during transfusion and that this tion of prehospital blood product transfusion during medical evac-
is a “no fail” task. In addition, they are instructed to label uation of combat casualties in Afghanistan with acute and 30-day
survival. JAMA. 2017;318(16):1581–1591.
their blood collection bag with their name. Other methods in- 5. Kotwal RS, Scott LLF, Janak JC, et al. The effect of prehospital
clude writing a unique mark on the donor arm and the bag. transport time, injury severity, and blood transfusion on survival
Prior to transfusion, there is a safety or final time out where of US military casualties in Iraq. J Trauma Acute Care Surg. 2018;
the instructor verifies that an autologous transfusion is taking 85(1S suppl 2):S112–S121.
place. To limit the impact of any vasovagal syncope during 6. Fisher AD, Miles EA, Cap AP, et al. Tactical damage control resus-
citation. Mil Med. 2015;180(8):869–875.
venipuncture, students are laid supine during venipuncture. To 7. McQuilten ZK WE, Yomtovian RA. Adverse consequences of au-
prevent ocular blood exposure, students are instructed to in- tologous transfusion practice. In: Transfusion Reactions. 4th ed.
sert with needle bevel down if using a bare metal needle and to 2012.
use eye protection. A medical kit with an epinephrine pen and

Risk Associated With Autologous FWB Training | 25