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1:1 blood transfusions for shock
Ronald Gross Rgross at harthosp.orgThu Feb 21 13:37:01 GMT 2008
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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 -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/
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