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Thu Feb 21 13:37:01 GMT 2008

Chris and Karim,

Sounds like something I mentioned earlier - i.e. a return to whole blood.  Fairly safe in the military, where the blood supply can be from a population that is screened yearly.  A bit more risky in the civilian world - and much more worrisome in some countries that in others.  And as to the decreasing use of whole blood in the current war, I am not sure of your assertion, Karim; I believe that the use of real time donors lined up to give to a fellow combatant who needs lots of blood now is used less often.  I think that it is used less frequently only because, as I have been told from folks in the CSH's over there, and flying the CCATs, the number of US casualties is going down, contrary to what the press asserts on the Nightly News.  

Best to you all,
Ron

>>> "Karim Brohi" <karim at trauma.org> 2/20/2008 7:47 PM >>>
Chris

Great comments.  I take your point about whole blood in austere
environments.  But it's dangerous - people do catch nasty diseases from it.
Of course it's a lot easier to give 6 units of whole blood that 6 red cells,
3 plasma and 1 platelets (the equivalent) and so of course you see the
effect and think 'cool!'. But in civilian practice, or if you have the
military machine such as the US, it should be possible to do better.  Indeed
it is my understanding the whole blood is now rarely used in Baghdad now
that apheresis platelets are available (along with plasma etc).

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Christos Giannou
Sent: 13 February 2008 15:42
To: trauma-list at trauma.org 
Subject: 1:1 blood transfusions for shock

I understand your concerns Karim, especially concerning one retrospective
military study, but a small note of caution when one speaks of "global
practice".

Many hospitals in the world (the majority?) do not have access to blood
components. For many of us, the standard is whole blood, as fresh as
possible, and usually donated by a family member. I understand that what is
under discussion is practice in the industrialised world -- and certain
capital cities of the Third World -- but would also mention that recent
"military studies" from Iraq and Afghanistan have also extolled the benefits
of fresh whole blood for shock.

One idea might be to start swinging the pendulum back a bit. I imagine there
is a whole cohort of senior, not to say elderly, surgeons on the list who
started their practice using whole blood, in glass bottles! (Wonderful piece
of equipment to have around for autotransfusion.)  Perhaps some basic
research in an antiquated pre-blood-component technique would be in order.
Our colleagues in the industrialised world would have to help us out,
however. Not a simple task to do much research in a bush hospital, although
the US military is trying with their forward surgical teams.

best regards,

-- 
chris giannou
senior surgeon
international committee of the red cross
Monemvasia Lakonia
23070 Greece
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1:1 blood transfusions for shock