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Comparison of platelet transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients (CME)

Authors

  • Jeremy G. Perkins,

    1. From the Walter Reed Army Medical Center, Washington, DC; the United States Army Institute of Surgical Research, Ft Sam Houston, Texas; the Connecticut Children's Medical Center, Hartford, Connecticut; the Washington Hospital Center, Washington, DC; the Madigan Army Medical Center, Tacoma, Washington; the Brooke Army Medical Center, San Antonio, Texas; the Armed Services Blood Program Office, Falls Church, Virginia; and the University of Texas Health Science Center, Houston, Texas.
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  • Andrew P. Cap,

    1. From the Walter Reed Army Medical Center, Washington, DC; the United States Army Institute of Surgical Research, Ft Sam Houston, Texas; the Connecticut Children's Medical Center, Hartford, Connecticut; the Washington Hospital Center, Washington, DC; the Madigan Army Medical Center, Tacoma, Washington; the Brooke Army Medical Center, San Antonio, Texas; the Armed Services Blood Program Office, Falls Church, Virginia; and the University of Texas Health Science Center, Houston, Texas.
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  • Philip C. Spinella,

    1. From the Walter Reed Army Medical Center, Washington, DC; the United States Army Institute of Surgical Research, Ft Sam Houston, Texas; the Connecticut Children's Medical Center, Hartford, Connecticut; the Washington Hospital Center, Washington, DC; the Madigan Army Medical Center, Tacoma, Washington; the Brooke Army Medical Center, San Antonio, Texas; the Armed Services Blood Program Office, Falls Church, Virginia; and the University of Texas Health Science Center, Houston, Texas.
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  • Andrew F. Shorr,

    1. From the Walter Reed Army Medical Center, Washington, DC; the United States Army Institute of Surgical Research, Ft Sam Houston, Texas; the Connecticut Children's Medical Center, Hartford, Connecticut; the Washington Hospital Center, Washington, DC; the Madigan Army Medical Center, Tacoma, Washington; the Brooke Army Medical Center, San Antonio, Texas; the Armed Services Blood Program Office, Falls Church, Virginia; and the University of Texas Health Science Center, Houston, Texas.
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  • Alec C. Beekley,

    1. From the Walter Reed Army Medical Center, Washington, DC; the United States Army Institute of Surgical Research, Ft Sam Houston, Texas; the Connecticut Children's Medical Center, Hartford, Connecticut; the Washington Hospital Center, Washington, DC; the Madigan Army Medical Center, Tacoma, Washington; the Brooke Army Medical Center, San Antonio, Texas; the Armed Services Blood Program Office, Falls Church, Virginia; and the University of Texas Health Science Center, Houston, Texas.
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  • Kurt W. Grathwohl,

    1. From the Walter Reed Army Medical Center, Washington, DC; the United States Army Institute of Surgical Research, Ft Sam Houston, Texas; the Connecticut Children's Medical Center, Hartford, Connecticut; the Washington Hospital Center, Washington, DC; the Madigan Army Medical Center, Tacoma, Washington; the Brooke Army Medical Center, San Antonio, Texas; the Armed Services Blood Program Office, Falls Church, Virginia; and the University of Texas Health Science Center, Houston, Texas.
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  • Francisco J. Rentas,

    1. From the Walter Reed Army Medical Center, Washington, DC; the United States Army Institute of Surgical Research, Ft Sam Houston, Texas; the Connecticut Children's Medical Center, Hartford, Connecticut; the Washington Hospital Center, Washington, DC; the Madigan Army Medical Center, Tacoma, Washington; the Brooke Army Medical Center, San Antonio, Texas; the Armed Services Blood Program Office, Falls Church, Virginia; and the University of Texas Health Science Center, Houston, Texas.
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  • Charles E. Wade,

    1. From the Walter Reed Army Medical Center, Washington, DC; the United States Army Institute of Surgical Research, Ft Sam Houston, Texas; the Connecticut Children's Medical Center, Hartford, Connecticut; the Washington Hospital Center, Washington, DC; the Madigan Army Medical Center, Tacoma, Washington; the Brooke Army Medical Center, San Antonio, Texas; the Armed Services Blood Program Office, Falls Church, Virginia; and the University of Texas Health Science Center, Houston, Texas.
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  • John B. Holcomb,

    1. From the Walter Reed Army Medical Center, Washington, DC; the United States Army Institute of Surgical Research, Ft Sam Houston, Texas; the Connecticut Children's Medical Center, Hartford, Connecticut; the Washington Hospital Center, Washington, DC; the Madigan Army Medical Center, Tacoma, Washington; the Brooke Army Medical Center, San Antonio, Texas; the Armed Services Blood Program Office, Falls Church, Virginia; and the University of Texas Health Science Center, Houston, Texas.
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  • the 31st Combat Support Hospital Research Group


  • The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Jeremy G. Perkins, MD, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307; e-mail: Jeremy.perkins1@us.army.mil.

Abstract

BACKGROUND: At major combat hospitals, the military is able to provide blood products to include apheresis platelets (aPLT), but also has extensive experience using fresh whole blood (FWB). In massively transfused trauma patients, we compared outcomes of patients receiving FWB to those receiving aPLT.

STUDY DESIGN AND METHODS: This study was a retrospective review of casualties at the military hospital in Baghdad, Iraq, between January 2004 and December 2006. Patients requiring massive transfusion (≥10 units in 24 hr) were divided into two groups: those receiving FWB (n = 85) or aPLT (n = 284) during their resuscitation. Admission characteristics, resuscitation, and survival were compared between groups. Multivariate regression analyses were performed comparing survival of patients at 24 hours and at 30 days. Secondary outcomes including adverse events and causes of death were analyzed.

RESULTS: Unadjusted survival between groups receiving aPLT and FWB was similar at 24 hours (84% vs. 81%, respectively; p = 0.52) and at 30 days (60% versus 57%, respectively; p = 0.72). Multivariate regression failed to identify differences in survival between patients receiving PLT transfusions either as FWB or as aPLT at 24 hours or at 30 days.

CONCLUSIONS: Survival for massively transfused trauma patients receiving FWB appears to be similar to patients resuscitated with aPLT. Prospective trials will be necessary before consideration of FWB in the routine management of civilian trauma. However, in austere environments where standard blood products are unavailable, FWB is a feasible alternative.

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