THOR-AABB Working Party Recommendations for a Prehospital Blood Product Transfusion Program

Figures & data

Table 1. Advantages of using low titer group O whole blood (LTOWB) over conventional components.

• Simplifies the logistics of the resuscitation by providing balanced resuscitation fluid in one bag instead of three

• More concentrated product compared to reconstituting whole blood with conventional components

• Provides cold stored platelets that have improved in vitro and perhaps in vivo hemostatic function compared to room temperature platelets in this patient population

• Provides for a longer shelf life for stored platelets compared to room temperature storage

• Provides for the availability of platelets where they might otherwise not have been available

• Reduces the bacterial contamination rate of a platelet-containing product

• Reduces the incidence of ABO mis-transfusion during the resuscitation

• Reduces donor exposures

• Transported under identical conditions as RBCs.

Table 2. Indications and storage characteristics of blood products that could be used in the prehospital resuscitation phase. Data taken from AABB Standard 5.1.8A (32). The listed times and temperatures might vary between jurisdictions, in particular outside of the US. Section 2.1 discusses the differences between storage and transport.

Blood product	Reason for transfusion	Storage conditions	Transport conditions	Maximum length of storage
Red blood cells (RBC)	Increase oxygen carrying capacity	1-6 °C	1-10 °C	ACD/CPD/CP2D: 21 days, CPDA-1: 35 days, additive solution: 42 days
Plasma	Correct coagulopathy, restore endothelial integrity	Once thawed: 1-6 °C	1-10 °C	Once thawed: 5 days from date product was thawed or original expiration, whichever is sooner, if issued as thawed plasma
Platelets (PLT)	Promote hemostasis	Conventional: 20-24 °C with continuous, gentle agitation Cold stored: 1-6 °C agitation optional	Conventional: as close as possible to 20-24 °C, maximum time without agitation: 30 hours Cold stored: 1-10 °C	Conventional: 24 hours to 5 days depending on collection system. Cold stored: according to manufacturer's written instructions
Low titer group O whole blood (LTOWB)	Contains all constituents of blood	1-6 °C	1-10 °C	CPD: 21 days CPDA-1: 35 days

Table 3. Antigens on red blood cells (a) and antibodies in the plasma (b) by ABO group

(a).

ABO Group	Antigens on RBCs
A	A
B	B
AB	AB
O	Neither
(b)
ABO Group	Antibodies in plasma
A	B
B	A
AB	Neither
O	A, B

Table 4. ABO compatibility between donor red blood cells (a) and plasma (b) and recipient ABO group

(a).

Recipient ABO group	Donor RCB Compatibility
A	A, O
B	B, O
AB	A, B, O, AB
O	O
(b)
Recipient ABO group	Donor plasma Compatibility
A	A, AB
B	B, AB
AB	AB
O	A, B, AB, O

Standards for blood banks and transfusion services. 32nd ed. Bethesda, MD: AABB; 2020.

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