Page 70 - JSOM Fall 2021

TABLE 2 Description of Casualties Receiving Blood Products Within AFRICOM
Origin
Age Gender Service Destination Description
30 years Male USN/active Djibouti 30-year-old man sustained a gunshot wound to the mandible. He was
Landstuhl evacuated to a US Navy ship where he was immediately taken to the OR.
They were unable to intubate so a cricothyrotomy was performed. He was
hypotensive and received 5 units of type-O negative whole blood, 4 units of
pRBCs, and 2 units of FFP. His estimated blood loss was 2L. His wound was
surgically packed for hemostasis and he was transferred to Landstuhl.
24 years Male USAF/active Djibouti 24-year-old man with ATV rollover with blunt force injury to the right groin.
Landstuhl Initially he was hemodynamically stable, and his FAST was negative. He was
taken to the OR for a right arterial bypass; he coded in surgery. He was given
7 units of pRBCs and 7 units of FFP. Bilateral chest tubes were placed and a
thoracotomy were performed. He was diagnosed with a blunt cardiac injury.
Unknown Male DoS Libya Unknown age male involved in Libyan Embassy attack with undocumented
Landstuhl mechanism of injury. Patient found to be in severe shock and received 6 units
of pRBCs on the ground and 1 unit en route. Patient was intubated prior to
transfer.
29 years Male USN/active Kenya 29-year-old man with gunshot wound to the left hip and thigh. A tourniquet
Landstuhl was applied, and patient was taken to surgery at a local hospital in Nairobi.
Patient had multiple surgical explorations, followed by multiple compartment
fasciotomy with significant hemorrhage, complicated by renal failure. Patient
was transfused a total of 9 units of pRBCs.
31 years Male USA/active Mali 31-year-old man injured by 40-mm grenade in Mali. A needle chest
Landstuhl decompression was performed followed by a right-side chest tube. Patient
transferred from Bamako, Mali to Ouagadougou for clinical intervention care.
Patient was transfused 2 units of pRBCs prior to flight evacuation.
33 years Male USN/active Kenya 33-year-old man with gunshot wound to the left thigh with femoral vessel
Landstuhl laceration. Two tourniquets were applied, and he was transferred for vascular
surgery intervention in Nairobi. Patient was transfused blood products that
were not specified type or volume.
24 years Male USN/active Kenya 24-year-old man with a gunshot wound to the high left thigh with femoral
Landstuhl vessel injury. He was transfused 2 units of unspecified blood products prior
to arrival the hospital in Nairobi where he underwent surgery. He was then
transferred to Landstuhl.
34 years Male USA/active Djibouti 34-year-old man with history of gastrointestinal bleeds that presented to the
Landstuhl medical clinic in Djibouti with lightheadedness and melanotic stools. He was
given 2 units of O-positive pRBCs and transferred to Landstuhl.
44 years Male USA/active Djibouti 44-year-old man with melanotic stools found have a gastrointestinal bleed from
Landstuhl an ulcer with presyncopal episodes. He was transfused 2 units of pRBCs. His
pretransfusion hematocrit was 21.6. He was transferred to Landstuhl where he
underwent esophagogastroduodenoscopy.
30 years Male USN/active Djibouti 30-year-old man with rectal bleeding over 1 week with 2–3 stools with bright
Landstuhl red blood. His hematocrit was 17.5. He was transfused 2 units of pRBCs
and transferred to Landstuhl for colonoscopy. He was noted to have a febrile
reaction to the blood but no other transfusion reaction symptoms.
OR = operating room, ATV = all-terrain vehicle, FAST = focused assessment of sonography for trauma, FFP = fresh frozen plasma, DoS =
Department of State, pRBC = packed red blood cell, USA = US Army, USN = US Navy, USAF = US Air Force.
TABLE 3 Case Data of Noting Challenges With Transfusions
Origin
Age Gender Service Destination Description
26 years Male USA/active Unknown 26-year-old with suicide attempt by way of toxic ingestion and cutting of his
South Africa arm. His arm was locally ligated to control the hemorrhage. He was found to
have a hemoglobin of 5.4g/dL. However, it appeared no blood products were
available, and the Tricare International service recommended against local
blood transfusion in undocumented location. Due to his unstable nature, he
was transferred to Johannesburg, South Africa.
31 years Male USN/active Seychelles 31-year-old with duodenal ulcer with history of nonsteroidal anti-inflammatory
Landstuhl drug use with syncopal episode. He had several episodes of maroon stools.
His hemoglobin was 7g/dL. Tricare International service advised that that
blood in the Republic of Seychelles is screened by the Ministry of Health Blood
Bank and the incidence of HIV is low, however screening standards are not
guaranteed. Due to underlying fears, the Servicemember declined the blood
transfusion recommended.
48 years Female PHS/active Zambia 44-year-old woman with presented with chest tightness, shortness of breath,
South Africa and fatigue in Lusaka, Zambia. Her hemoglobin was 7.1g/dL. The etiology
for her anemia was unclear but they noted concerns for malaria. Tricare
International advised that local healthcare does not meet their standards and a
blood transfusion was at high risk for HIV and hepatitis. She was evacuated to
Pretoria, South Africa.
USA = US Army, USN = US Navy, PHS = Public Health Service, HIV = human immunodeficiency virus.

68 | JSOM Volume 21, Edition 3 / Fall 2021