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screening prior to deployments for all O blood group Service- United States Government.” Title 17 U.S.C. 101 defines U.S.
members. Also, the development of a point-of-care testing Government work as work prepared by a military Service-
LTOWB titer card or other such capabilities can help track member or employee of the U.S. Government as part of that
titer levels while ships are underway and without blood bank person’s official duties.
capabilities. The current commercially available whole blood
collection and transfusion kits contain portable and compact Disclosures
Eldon cards for point-of-care confirmation of ABO blood The authors have no financial disclosures to report.
group for WBBs in austere settings (Chinook Medical Gear,
Tulsa, OK). This point-of-care ABO testing card uses three Presentations
panels impregnated with dried antibody sera anti-A, anti-B This study was presented at Naval Medical Forces Pacific Re-
(for ABO grouping), and anti-D (for Rhesus grouping), respec- gional Research Competition, April 12, 2023 in San Diego, CA
tively, and one control panel that does not contain antibodies. and the 2023 Military Systems Health Research Symposium,
Currently, there is no a similar point-of-care test to identify August 15, 2023 in Kissimmee, FL.
LTOWB donors by determining whether isohemaggluttinin
titers (anti-A and anti-B) are <1:256. Quantitative measures Funding
via manual saline dilution or automated gel assay are labor-in- No funding was received for this work.
tensive, require significant training, and are not suitable for
43
DMO. However, it would be reasonable to assume that a References
qualitative negative or only weakly positive hemagglutination 1. Deaton TG, Auten JD, Betzold R, et al. Fluid resuscitation in
point-of-care test could reliably indicate a total or partial defi- Tactical Combat Casualty Care; TCCC guidelines change 21-01.
44
ciency of antibodies against the donor blood group. A future 4 November 2021. J Spec Oper Med. 2021;21:126–137. DOI:
10.55460/JYLU-4OZ8.
capability would be the development of a qualitative point-of- 2. Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Hol-
care isohemaggluttin titers (anti-A and anti-B) test for SSTs to comb JB. Warm fresh whole blood is independently associated
screen donors that have not undergone predeployment screen- with improved survival for patients with combat-related trau-
ing or to retest eligible LTOWB donors. matic injuries. J Trauma. 2009;66:S69–76. DOI:10.1097/TA.
0b013e31819d85fb.
3. Nessen SC, Eastridge BJ, Cronk D, et al. Fresh whole blood use
Conclusion by forward surgical teams in Afghanistan is associated with im-
proved survival compared to component therapy without plate-
Cold-stored LTOWB is the preferred resuscitation fluid for se- lets. Transfusion. 2013;53 (Suppl 1):107S–113S. DOI:10.1111/
verely injured warfighters. However, given the limitations of trf.12044.
a deployed at sea environment, a WBB utilizing all O whole 4. Auten JD, Lunceford NL, Horton JL, et al. The safety of early
blood donors may potentially be the only practical resource fresh, whole blood transfusion among severely battle injured at
available for SSTs performing damage control resuscitation US Marine Corps forward surgical care facilities in Afghanistan.
on nontraditional medical receiving vessels. The current De- J Trauma Acute Care Surg. 2015;79:790-796. DOI:10.1097/TA.
0000000000000842.
partment of Defense Instruction 6480.04 requires blood group 5. Yazer MH, Cap AP, Spinella PC. Raising the standards on whole
testing of all Servicemembers prior to deployment. The testing blood. J Trauma Acute Care Surg. 2018;84:S14–S17. DOI:10.1097/
allows for a prescreened LTOWB WBB to mitigate the risk of TA.0000000000001778.
RDCR or mass casualty events. Capability development, ed- 6. Butler FK, Burkholder T, Chernenko M, et al. Tactical combat
ucation, and training efforts should focus on optimizing the casualty care maritime scenario: shipboard missile strike. J Spec
performance of LTOWB WBB on maritime platforms with Oper Med. 2022;22:9–28. DOI:10.55460/ZT9J-EI8Z.
limited blood product storage or screening capabilities. Future 7. Tadlock MD, Gurney J, Tripp MS, et al. Between the devil and
the deep blue sea: A review of 25 modern naval mass casualty
research, development, technology, and evaluation initiatives incidents with implications for future distributed maritime op-
should also investigate analogue blood products as alterna- erations. J Trauma Acute Care Surg. 2021;91:S46–S55. DOI:10.
tives to augment resuscitation capacity in a contested logistics 1097/TA.0000000000003199.
maritime domain. 8. Miller BT, Lin AH, Clark SC, Cap AP, Dubose JJ. Red tides: Mass
casualty and whole blood at sea. J Trauma Acute Care Surg.
2018;85:S134–S139. DOI:10.1097/TA.0000000000001831.
Author Contributions 9. Monaghan WP, Levan DR, Camp FR. Military blood banking:
RKC, MOO, JMM, BPB, ER, TB, JAG, and JDA collected and blood transfusion aboard a Naval hospital ship receiving multiple
analyzed the data and drafted the original manuscript. JDA, casualties in a combat zone, a controlled medical environment.
TGD, JWB, and APC designed this research, reviewed, and ed- Transfusion. 1977;17:473–478. DOI:10.1046/j.1537-2995.1977.
ited the manuscript. All authors read and approved the final 17578014586.x.
manuscript. 10. Song KH, Winebrenner HM, Able TE, Bowen CB, Dunn NA,
Shevchik JD. Ranger O Low Titer (ROLO): Whole blood trans-
fusion for Forward Deployed Units. Mil Med. 2021;188(7–8):
Disclaimer e2733–e2737. DOI:10.1093/milmed/usab473.
The views expressed in this article reflect the results of re- 11. CNAP-CNAL INST 6480.1-walking blood bank. https://flank
search conducted by the author and do not necessarily reflect speed.sharepoint-mil.us/sites/CPF-CNAP-HQ/Health/_layouts/15
the official policy or position of the Department of the Air /AccessDenied.aspx?Source=https%3A%2F%2Fflankspeed%
Force, Department of the Navy, Department of Defense, or the 2Esharepoint%2Dmil%2Eus%2Fsites%2FCPF%2DCNAP%
United States Government. 2DHQ%2FHealth%2FShared%20Documents%2FForms%2
FAllItems%2Easpx%3FnewTargetListUrl%3D%252Fsites
%252FCPF%252DCNAP%252DHQ%252FHealth%252FShared
CDR Jonathan D. Auten is a military Servicemember of the %2520Documents%26viewpath%3D%252Fsites%252
United States government. This work was prepared as part of FCPF%252DCNAP%252DHQ%252FHealth%252FShared
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