A Panoramic View of Blood and Blood Product: Use in the Past Half Century

Abstract

ABSTRACT Background Many changes regarding the use of blood and blood products for resuscitation of severely injured patients have occurred in the past 50 years. This study presents these changes. Study design A review of resuscitation regimens over 50 years is presented. Results During the 1960s, hemorrhage shock (HS) was treated with whole blood (WB) and balanced electrolyte solution (BES); fresh WB restored the labile factors (FV and FVIII) during massive transfusion (MT). When component therapy with red cells (RBC) was started, plasma (FFP) had to be added; patients with MT received a 2/5 RBC/FFP ratio. Platelets were reserved for oozing or counts below 50,000. During the Vietnam conflict, many recommended supplemental albumin therapy. A large prospective randomized study showed that albumin therapy caused many adverse effects including coagulopathy. During the 1980s, the National Institute of Health (NIH) responded to a shortage of FFP by initiating a consensus development conference (CDC) which concluded that FFP was not indicated without an established coagulopathic bleeding; animal HS models showed FFP was beneficial. During the 1990s, military surgeons recommended a 1/1 FFP/RBC ratio. Studies, herein, demonstrated that a 0.3/1 FFP/RBC ratio effectively restored procoagulants; whereas, ratios above 0.45/1 FFP/RBC caused increased BES needs and longer stays. Conclusion Initial therapy for HS should be BES followed by RBC to maintain hemoglobin, perfusion and urine output. FFP should be supplemented after 5 units RBC using a 0.5 FFP/ RBC until hemostasis is obtained. Platelets should be added for ‘medical’ oozing and thrombocytopenia. How to cite this article Lucas CE. A Panoramic View of Blood and Blood Product: Use in the Past Half Century. Panam J Trauma Critical Care Emerg Surg 2012;1(3):139-145.