Thread by @TransfusionWM

Now Mark Yazer and Simon Stanworth debating the use of whole blood. First Prof Yazer on the pros #bbts2017

First makes the point that fixed ratios are not for the duration of bleeding but should be guided by blood results when available #bbts2017

In Pittsburgh they transfuse STORED COLD whole blood (NB warm 'acute' blood also given in some settings e.g. military) #bbts2017

In US universal group =Oneg, hightitre neg. Israel transfuse O neg high titre untested whole blood with no reported adverse events #bbts2017

But reports elsewhere of O neg 'high titre' blood leading to haemolysis #bbts2017

Whole blood provided quicker than component therapy in retrospective analyses #bbts2017

Every minute in delay of blood transfused in PROPPR led to increase in mortality of 5% (2y analysis) #bbts2017

Whole blood more concentrated than comment therapy #bbts2017

Cold stored platelets are rubbish for prophylaxis in haemonc but great for trauma patients w active bleeding! #bbts2017

ED fridge in Pittsburgh has whole blood, O pos RBC, O neg RBC, thawed A plasma and AB plasma...

Whole blood is from male donors (TRALI), HT neg, leucocyte filtered through plt sparing filter and stored for 15 days #bbts2017

Should read 'component' therapy! Autocorrect...

Now giving WB to children too but >3 years so that ABO ags expressed on non blood tissues, to help mop up antiA/B #bbts2017

18 children so far. 8 group O, 10 group A. No haemolysis #bbts2017

WB recipients don't do worse that component therapy and may have less ITU LOS (small numbers) #bbts2017

They don't run platelets through rapid infuser in Pittsburgh so need 2 lines for component therapy, but WB can be #bbts2017

STAT study looking at recips of group A plasma - no difference in outcomes between recip blood groups #bbts2017 onlinelibrary.wiley.com/doi/10.1111/tr…

Prof Yazer makes a strong case for WB. Safe, effective and feasible for trauma patients. Simon Stanworth next to argue against #bbts2017

Dr Stanworth going for lack of evidence base. Argues we don't want WB to be 'no worse' that std care but better! #bbts2017

Fashions come, fashions go... but why did it go out of vogue in the first place? #bbts2017

PROPPR reported benefit for 1:1:1 vs 1:1:2 but only reduced death from exsanguination, not24h or 30d mortality #bbts2017

Recent correspondence argues no difference betw gps &difficulty distinguishing different types of injury onlinelibrary.wiley.com/doi/10.1111/tr… #bbts2017

WB is platelet deplete even if plt sparing filters used- 70 x10^9/unit of WB versus 250 in a unit of plt #bbts2017

Little data on storage of all components together wrt interactions &subsequent safety #bbts2017

Are we addressing key deficit in major bleeding? Plasminogen and Protein C in plasma may cause more fibrinolysis #bbts2017

Fg levels on admission in trauma predict mortality. I spy a plug for @CRYOSTAT_2 ... Cryo vs nil (+std MHP) in trauma haemorrhage #bbts2017

Sometimes trials don't show what we expect. PATCH study is classic example: ... 1/2

2/2 ... plt transfusion in ICH in pts on antiplt showed worse outcomes in pts who got plt transfusion #bbts2017

Concern about mission creep and WB being used for non trauma patients with major bleeding #bbts2017

Villanueva study in GI bleeding showed better outcomes with restrictive RBC thresholds. Could same be said in civilian trauma? #bbts2017

Trauma patients are becoming more elderly and not comparable to military experience #bbts2017

Should plasma be given ahead of red cells? Trial just completed in Pittsburgh.... results awaited... #bbts2017

Are we prioritising oxygenation or prevention/reversal of coagulopathy? #bbts2017

Increasing age of trauma patients begs question should platelets be given first to those on antiplatelets? #bbts2017

But volume handling different in the elderly and need to be v careful about TACO #bbts2017

More research needed says Simon #bbts2017