Page 27 - JSOM Spring 2020

FIGURE 3 ROLO Working Group, 2014 RDCR Symposium. for transfusion-transmitted disease (TTD) and titers within 2
weeks of deployment and after 105 days to coincide with op-
erational timelines. Double-checked and standardized ROLO
rosters and identification cards were created (Figure 4) to pre-
vent misidentification of potential donors.
Outcomes from the first seven series of testing had a total of
560 volunteers tested, 330 (59%) were identified as low titer.
Other pertinent results found 87 O negatives, 3 A positives,
1 B positive, 1 hepatitis C virus, and 1 hepatitis B virus.
Whereas the additional findings of TTDs presented challenges
for the asymptomatic individual donors, the findings gave the
team additional confidence in the process to identify TTDs and
mis-typing in potential donors. Shortly after the commencing
of titer testing, in August 2015, 1st Battalion, 75th Ranger
Regiment became the first unit to deploy with this capability.

FIGURE 4 ROLO identification card.

use an existing contract with QualTex Laboratories, San An-
tonio, TX, to perform the titer testing. One year after concept
development, in May 2015, testing began on 3rd Battalion,
75th Ranger Regiment. Initial results demonstrated of the 82
potential donors, 9 were low titer (no reaction), 33 were defi-
nitely high titer (2+ at the 1:128 dilution), 40 were borderline
(w+ or 1+); no hemolysis was noted on any of the samples.

Based on data from World War II, the team met and the de-
cision was made to change the titer level to <1:256. When a
smaller group from the first batch were retested at <1:256, 31
(77.5%) donors were found to be low titer. With these out-
comes, the team with support from the command of the 75th
Ranger Regiment, began titer testing graduates of the Ranger
Assessment and Selection Program (RASP) I during their med-
ical processing as well as all group O members before deploy-
ment. This was the start of an internal walking blood bank
where approximately one-third of the force was identified for
immediate donation for transfusion.

On entry into the US Army, all Soldiers have their blood
drawn to determine their blood type. Once the Soldiers who
are bound to service in the 75th Ranger Regiment pass their
assessment and selection, Soldiers with group O blood type are
identified using the Medical Protection System (MEDPROS).
The group O Soldiers are given a presentation on the program,
and given the option to volunteer to be in the program. Once In February 2016, the team began to evaluate the ability to
they agree to participate, the local blood donor center pro- draw units of LTOWB from identified donors of the support
cesses them in accordance with their blood donor screening personnel, storing the units to take on missions. The first
process, substituting the blood draw for a titer test. five units were drawn from support personnel who would
not be on missions (Figure 5). These units were collected in
The sample would confirm ABO as group O and test IgM citrate-phosphate-dextrose (CPD) collection bags with a 21-
for anti-A and -B (IgM <256). These results were then sent day shelf-life. Based on the limited number of support person-
to Sheila Rudesheim (Quality Assurance Manager, Sulli- nel who were LTOWB donors who could only donate every 56
van Memorial Blood Center), who manually entered the re- days and the short shelf-life, it was quickly realized this was
sults into the Theatre Medical Data Store (TMDS). Access not a sustainable practice.
to TMDS was given to medical officers, senior NCOs, and
medical support personnel to track and cross-check all donor With the support of US Central Command (CENTCOM) and
rosters for use in combat. Donor protocol required retesting the ASBP, a system was developed to ship cold stored low titer

Use of Whole Blood in the Battlefield | 23