Clinical Practice - new!
Welcome to our new Clinical EMS Practice column. It is written by Clinical Education Specialist Chris Chi, AMR Boulder/Longmont, and will be published quarterly.
Whole Blood
With the upcoming changes to whole blood in the state of Colorado here is a clinically relevant reminder of the basics of collecting blood. The need for blood is relentless. In the United States alone, someone needs a transfusion every two seconds. Despite this high demand, not enough people donate. Only about 38% of the U.S. population is eligible to donate blood due to factors like age, health, and travel history, but less than 10% actually do so each year. (Commonly only about 3%) This creates a gap between the demand for and supply of blood, a gap that can widen during holiday periods or in emergencies when fewer people donate.
Blood type plays a critical role in transfusions, with type O-negative blood being particularly important. As the universal donor type, O-negative blood can be given to patients of any blood type, especially in emergencies when there’s no time to type and cross-match the recipient's blood. O-negative blood is the most commonly requested blood however, only about 7% of the population has O-negative blood, a precious resource often in short supply.
Low Titer O+ Whole Blood (LTOWB) can help solve this problem. LTOWB is blood that has a very small amount of anti-A/B- hemagglutinin (antibodies) titers meaning that the risk of reaction to the blood is much lower and fairly safe. LTOWB is especially useful in the context of increasing the availability of blood. LTOWB can come from both O-neg and O-positive blood, the most common blood type group. This increases the donation pool significantly. The act of donating blood is a simple yet profound way to save lives. Each donation can save up to three lives, and with just an hour of your time, you can make an immense difference.
Once collected, blood is not used immediately. It undergoes rigorous testing for infectious diseases such as HIV, hepatitis B and C, and syphilis. Following testing, blood is commonly separated into components: red blood cells, platelets, and plasma. Each component is stored differently— red blood cells can be refrigerated for up to 42 days, platelets are kept at room temperature in agitators for up to five days, and plasma can be frozen for up to one year. Whole Blood can be stored for around 30 days. With the small amount of time blood is available and the immense demand frequently forces blood to places with the most likelihood it will be used leaving rural areas limited without the valuable resource.
An article published in JAMA earlier this year showed a noteworthy increase in survivability when patients received blood early in their care highlighting the value of blood accessibility. Thankfully programs are active to help not only ambulances but also smaller hospitals access blood in more rural settings. Colorado’s Whole Blood initiative aims to increase the availability of blood by cycling blood efficiently from low-use rural areas to high-use trauma centers helping ensure it is not wasted while simultaneously making it available to rural areas. Colorado has recently established the Colorado Whole Blood Coalition to further examine the feasibility of LTOWB for prehospital operations and advanced trauma care.
Chris Chi can be contacted at (720) 204-2102 ext. 707 and at [email protected].