Page 48 - JSOM Winter 2022

Where Do We Stand on
“Buddy Transfusion” During Military Operations?

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Yann Daniel, MD, MPH *; Clément Derkenne, MD, MPH ;
Pierre Mahé, MD ; Stéphane Travers, MD, PhD ; Christophe Martinaud, MD, PhD 5
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ABSTRACT
Warm fresh whole-blood transfusion between comrades on and primary hemostasis. In addition, platelets play a major
the battlefield, also known as “buddy transfusion,” has been role in coagulation propagation beyond primary hemostasis.
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thrust back into the limelight for several years now. It means Likewise, it is now well documented that systemic blood fail-
drawing blood on the battlefield, once a bleeding soldier needs ure sets in after a severe hemorrhagic trauma, combining trau-
a transfusion, from one of their uninjured companions and ma-induced coagulopathy, trauma endotheliopathy, and the
immediately infusing it. It is a lifesaving procedure, effective decrease in oxygen transportation capacity. All of these com-
and hardy. This work aims to answer the main questions that bined lead to overall tissue ischemia. Red blood cell (RBC) in-
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military caregivers might have about it: interest of this proce- take is the only way to address this oxygen debt. As such, it is
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dure, donor and recipient safety, and hemostatic capacity of currently recommended to provide a bleeding trauma patient
the blood collected this way. with blood products in a 1:1:1 ratio for plasma, platelets, and
RBCs. Whole blood (WB) thus appears as a perfect all-in-one
Keywords: blood transfusion; war-related injuries; hemostasis; product, providing all the necessary components.
physical exertion; military deployment; thrombin; transfusions;
buddy transfusions; whole blood Another essential point to understand is that blood product
administration must be made early in hemorrhagic trauma
management. It must be started at the presurgical phase
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Introduction when blood bank products are not available yet. The trans-
port of blood products to the field is also possible. This allows
With the last several years, warm fresh whole-blood trans- laboratory tests and screening for transfusion transmissible
fusion between comrades on the battlefield has been thrust diseases to be carried out in the blood bags before the mission.
back into the limelight. Fresh whole blood refers to whole Despite being associated with logistical issues (cold chain,
blood collected on an emergency basis from a “walking blood cube and weight, and resupply constraints related to the shelf
bank.” When a bleeding soldier needs a transfusion, and life of blood products), this strategy is widespread in Western
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fresh whole blood is drawn on the battlefield from one of his armed forces. Despite this, there are still unexpected situa-
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uninjured companions and immediately infused to him, it is tions in which a blood collection in the field may be required,
termed “warm fresh whole blood.” Since the blood is donated even though the combatants did not take blood products with
by a combat buddy, it is also known as “buddy transfusion.” them (often due to evacuation difficulties, logistical remote-
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This lifesaving procedure – both effective and hardy – still re- ness, unanticipated situations, etc.).
quires caution to ensure complete safety for both the donor
and recipient. This work aims to answer the main questions An obvious benefit of a warm fresh whole-blood strategy is
that military caregivers might have about performing such a thus logistical. Warm fresh whole blood is always available,
procedure on the field. even behind enemy lines, during operations requiring high mo-
bility and a light footprint, from the moment the personnel
Why Consider a “Buddy Transfusion” Procedure? is trained to the procedure and equipped with collection bag.
Warm fresh whole blood is maintained indefinitely at 37°C
Blood products are the cornerstone of the management of without storage constraints or the need for equipment (cool-
bleeding trauma patients. Plasma infusions have been widely ers, batteries, etc.). However, its additional advantage is qual-
used on the battlefield since the reemergence of freeze-dried itative. Because it is not infused with additive solutions and
plasma, although their availability is still limited. Plasma pro- anticoagulant, whole blood consists of – for an equal amount –
vides coagulation factors, allows for volume expansion, and more platelets, more RBCs, and more coagulation factors than
has other beneficial effects, to include targeting endotheliop- reconstituted blood from components.
athy. Plasma infusion increases the survival of major trauma
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patients among both war casualties and injured civilians. Nev- Another advantage could be that warm fresh whole blood is
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ertheless, plasma has only a low or zero effect on oxygenation not stored but immediately used. Storage of blood products
*Correspondence to yadaniel@outlook.fr
1 Dr Yann Daniel is affiliated with the 7ème AMS, French Military Health Service, Lorient, France. Dr Clément Derkenne is affiliated with the
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1ère AMS, French Military Health Service, Versailles, France. Dr Pierre Mahé is affiliated with the 1ère CSS-FS, French Military Health Service,
Vélizy-Villacoublay, France. Dr Stéphane Travers is affiliated with the Paris Fire Brigade, French Military Health Service, Paris, France. Dr Chris-
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tophe Martinaud is affiliated with the French Military Blood Institute, French Military Health Service, Clamart, France.
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