Severe trauma patients can now receive whole blood at UCHealth Medical Center of the Rockies through a systemwide program intended to save lives.
Used in transfusions by the U.S. military since at least World War I, whole blood for trauma patients can improve coagulation, reduce exposure to multiple donors and be given more efficiently when time is crucial.
“Rather than four different bags, I can just hang one bag,” said Dr. Warren Dorlac, MCR Trauma Medical Director, who helped lead the effort to start UCHealth’s whole blood program.
As a retired U.S. Air Force colonel who previously served as the trauma medical director for Landstuhl, a U.S. military hospital in Germany, he brings extensive experience to the program. Although he said military standards allow for troops in some cases to receive fresh blood while it’s still warm from the donor, whole blood units at UCHealth go through a 48-72 hour testing period and are refrigerated up to 21 days.
Four Medical Center of the Rockies patients have received whole blood transfusions since the program went live in November in the UCHealth Northern Colorado Region.
Until recently, adult trauma patients in life-threatening conditions, who needed transfusions in civilian hospitals, would be expected to received blood that’s been separated into components. Dorlac said component blood became widely used since the 1970s because of its versatility – serving not just trauma patients but hematology patients who only needed platelets, anemic patients needing red blood cells and others needing plasma.
“Trauma patients need all of those products,” Dorlac said. “And they need them all in a balanced form… Trying to mimic what we are bleeding, which is whole blood and seems to work best for the patient.”
‘The best chance for survival’
Whole blood programs increasingly have been adopted at dozens of hospitals and trauma centers across the country. In South Texas, whole blood transfusions are now available on all medical transport helicopters in a 26,000-square-mile region, according to a report from University of Texas Health Science Center at San Antonio.
“Using whole blood makes sense. Military studies in the Middle East showed that a quick response — strengthened by a combination of the three blood components or, in essence, whole blood — provided the best chance for survival,” according to the report.
Whole blood also results in fewer donors per unit: When a patient receives four units of whole blood, it comes from four donors. For the same amount of component blood, more than a dozen donors may have contributed.
“Every time you get a transfusion from a different donor, you run the risk of increased exposure to infection diseases, development of blood related diseases, or development of antibodies making future blood transfusion less compatible,” Dorlac said.
UCHealth Memorial Hospital Central in Colorado Springs was the first in the system to introduce its whole blood program. It went live in mid-September.
“Shock resuscitation with whole blood for massive bleeding has been the subject of many research studies. Those studies show us this is a safe technique to use, and that when used in the right situations, it can save lives,” said Dr. Brian Leininger, a trauma surgeon who worked to start the protocol at Memorial Central.
“This is the type of important advancement in trauma care that a Level I trauma center like Memorial Central brings to the community it serves.”
Local donors needed
Shortly before the program launched in Northern Colorado, two national blood organizations expected to supply the whole blood said they wouldn’t immediately be able to participate.
UCHealth Garth Englund Blood Center in Fort Collins stepped in immediately to create a very cost effective program in five weeks.
“If we didn’t have a mission focused local blood center, we would still be caught up in the discussion phase. on where to get the blood,” said Christine Thorkildsen, manager of trauma services at MCR. “We had great collaboration within all our departments, and it’s up and running.”
The program required designated bags for collection, a group of donors, new policies and procedures, and a review of FDA requirements. George Bost, UCHealth regional director of laboratory services, said six months would have been normal, but the quick turnaround time “is a testament” to the teamwork involved.
Because it comes from a local blood center, the whole blood patients receive at MCR is likely to be from a local resident. A person can donate whole blood every 51 days. And men with O-positive blood type who meet eligibility requirements are encouraged to donate.
“The moment you give whole blood,” Bost said, “you are giving a fighting chance to our most severely injured trauma patients.”