When a trauma patient arrives at a hospital with life-threatening injuries, blood is often the best tool doctors have to give the patient a fighting chance.
“Being able to give blood to patients buys us time and staves off rapid death from low blood pressure or blood loss,” said Dr. Chris Dennis, a trauma and acute care surgeon with UCHealth.
Giving whole blood to patients with traumatic injuries is a practice first proven in the military and has since been adopted in the last decade by trauma centers across the country, replacing older methods like giving IV fluids as a first line of treatment.
“Whole blood has all the blood components: red blood cells, platelets and plasma,” Dennis said. “Things like IV fluids, used for years for trauma resuscitation, require such large volumes to be administered that they can cause problems with the lungs or heart. This can make recovery more difficult. Additionally, IV fluids alone can make trauma patients more prone to bleed.
“With whole blood, we can give a patient less volume and they get all the benefits of the various blood components that were traditionally given separately.”
Although only about 20% of trauma patients who arrive at the hospital need blood, it is critical for survival.
Such was the case with 35-year-old Keith Thiel of Fort Collins.
Blood products needed in critical trauma cases
In August 2021, Thiel was heading home in his Honda Accord from the Morrison, Colorado communications business he owns with his uncle. He’d stopped by a friend’s house to get something and was heading onto U.S. Highway 60 when he was T-boned by another vehicle going 55 mph. Thiel has no recollection of the accident or much of the month after. Dennis was the admitting physician when Thiel arrived by ambulance at UCHealth Medical Center of the Rockies in Loveland.
“He was in rough shape,” Dennis said. “He was minimally responsive. Not truly comatose, but he wasn’t responding to anything around him.”
Within minutes, Dennis and his team inserted a breathing tube. Thiel’s brain wasn’t functioning well, and his blood pressure was about 40 points below normal. The trauma team began providing whole blood.
“Low blood pressure is an outward sign the patient has some sort of internal hemorrhage, has lost a lot of blood before getting to us, or has a serious problem with their spinal cord or brain,” Dennis said. “So, our initial goal, at a bare minimum, is to raise their blood pressure enough to assure their vital organs are getting sufficient blood flow to prevent further damage. The whole blood we are able to give helps to restore adequate blood flow and helps the body form blood clots to staunch further bleeding.”
Where does trauma blood supply come from?
The UCHealth Garth Englund Blood Donation Center collects an average of 203 units of whole blood per week. Almost all of those units are separated into red blood and platelets, which are provided to Medical Center of the Rockies, UCHealth Poudre Valley Hospital in Fort Collins, UCHealth Greeley Hospital, UCHealth Longs Peak Hospital and Estes Park Health. However, three units of blood each week are kept whole so that the Medical Center of the Rockies trauma team has supplies when they need them. Whole blood has a shelf life of 21 days.
That supply comes from the generosity of blood donors and the trauma team relies on specific male blood donors, said Anna Johnson, manager of laboratory services at Poudre Valley Hospital.
“Only low titer (testing done to see how many antibodies are present) O-positive male donors can be used for the trauma team’s purpose,” Johnson said. Blood from donors not in this group may possess antibodies that can be harmful to trauma patients.
The center collects blood through about a half-dozen weekly blood drives and donor visits to the center’s two locations, 1025 Pennock Place, Suite 104, Fort Collins, Colorado, and 2500 Rocky Mountain Ave., Loveland, Colorado.
A blood donation at Garth Englund Blood Donation Center takes less than one hour. There is a brief check-in where donors provide their age, weight and health history.
A person must be 18 years or older to donate (or 17 with a guardian’s permission). New donors must weigh at least 120 pounds and be in good health. Prior donors must weigh at least 110 pounds and have had no complications during previous donations. Military service members who have historically not been able to donate may qualify now due to lifted restrictions, and people who have recently gotten a tattoo may also be eligible to donate.
After check-in, the process of obtaining one unit of whole blood takes about 6-12 minutes. The patient is monitored by the blood center staff. Afterward, the donor is sent home with a snack.
In most cases, whole blood is separated into two parts: red blood cells and plasma. Whole blood for the trauma team is also held back, Johnson said.
People also may choose to donate platelets or double red blood during a slightly longer process. This automated process is called apheresis, which allows the donor to give blood that is then separated into its three basic parts: platelets, red cells (at double the amount of a normal donation) and plasma. The selected component of blood donated is taken and the other parts are returned to the donor.
Donating blood is an altruistic gift that saves lives, Dennis said.
“Although they are the minority of our trauma cases, some who do need blood may need enough to replace their whole blood volume twice over,” he said. “And almost always, these patients require major operations.”
The average-sized adult has anywhere from 5 to 7 liters of blood in their body. Thiel needed 16 liters of blood throughout his hospital stay.
How blood products are used to save lives
Frank DiPiazza, Thiel’s stepfather, remembers getting a call about the accident as he and Thiel’s mother, Teri, were getting ready for bed.
“We were petrified,” DiPiazza said. “They told us it wasn’t looking good and that we needed to be prepared … We don’t even like to talk about it now.”
Thiel’s first blood transfusion at the hospital gave doctors time to figure out the extent of Thiel’s injuries.
“He had some obvious injuries to extremities but being able to give him blood bought us a bit of time in terms of stabilizing his vitals so we could get a CT scan of his body,” Dennis said. “That turned out to be crucial because it helped us identify bleeding in his brain, an injury to his aorta and major injuries in his abdomen. All of these injuries required surgery to save his life.”
Thiel had a torn aorta, the main artery that carries blood away from the heart to the rest of the body, which is often a fatal injury. He also had a lacerated bladder and liver, traumatic brain injury, a broken tibia and pelvis, and a compound break to his fibula.
“For people like Thiel, whose injuries are very serious, the people that donate blood are helping both the patients and us to give the patient enough time to heal from their injuries. Without that ability, we’d see a lot more deaths and see it earlier on.”
Blood donors are critical to patients’ recovery
During his hospital stay, Thiel had several surgeries to repair his aorta, organs, pelvis and leg.
After healing at Medical Center of the Rockies, he transferred to Poudre Valley Hospital for rehabilitation. There, he worked with occupational, physical and speech therapists.
Thiel went home on Sept. 22, 2021, after 44 days in the hospital.
“Everyone was surprised,” Thiel said. “They thought I’d need to be there another few months.”
Thiel is no longer using his wheelchair. He still uses a cane when out and about, and he uses his walker when taking his 4-year-old American Bulldog Terrier, Kaiju, for a walk.
Before Thiel’s accident, his friend was teaching him how to work on cars. The Honda he had been working on was destroyed in the wreck, but Thiel hopes to one day be able to find a new vehicle and continue learning.
He can’t wait to get back outdoors to camp and on his bicycle, two things he’s loved all his life.
Until then, he’s doing what he can to help his uncle with the business. This Thanksgiving he spent hours in his kitchen baking peanut butter and spritz cookies, and pumpkin muffins to give to clients to show gratitude.
As he reflects on the holidays, Thiel said he is thankful for his friends and family, including his mom and Frank, who have helped him heal since the accident, the medical staff at UCHealth that saved his life, and the blood donors who made it all possible.