Blood On Board — Maryland State Police Whole Blood Program

Frequently Asked Questions

1. WHAT PATIENTS ARE CANDIDATES TO RECEIVE WHOLE BLOOD?

The Maryland Medical Protocol for Low Titer O+ Whole Blood (LTO+WB) Transfusion can be found here: Maryland State Whole Blood Transfusion Protocol

2. WHAT IS LOW TITER O+ WHOLE BLOOD (LTO+WB)?

LTO+WB is an FDA licensed and AABB approved blood product for emergency release in life-threatening situations where blood is needed immediately and the patient's blood type is unknown. It is the initial blood product of choice for massive hemorrhage used in the R Adams Cowley Shock Trauma Center as well as more than 100 other trauma centers in the U.S.

3. HOW IS IT MADE?

Blood is collected from volunteer donors, screened for disease, and verified to have non-significant levels (low titers) of antibodies against Type A or B blood. White Blood Cells are filtered out, but the blood is otherwise left whole with plasma and platelets to promote clotting and red blood cells to carry oxygen.

4. WHY IS O+ BLOOD USED AND NOT O-?

There is not enough supply of O- blood. Only 7% of the U.S. population has O- blood type, compared to 37% who are O+.

5. IS IT SAFE TO GIVE RH+ BLOOD TO PATIENTS WHO ARE RH-?

Most agree that the risk of imminent death shifts the risk/benefit consideration strongly in favor of RH- patients receiving RH+ blood. The risk of complications is considered to be very low.

McCoy CC, Montgomery K, Cotton ME, Meyer DE, et al. Can RH+ whole blood be safely used as an alternative to RH- product? An analysis of efforts to improve the sustainability of a hospital's low titer group O whole blood program. J Trauma Acute Care Surg. 2021;91(4):627-633.

6. WHAT ABOUT WOMEN OF CHILDBEARING AGE WHO ARE RH-?

Again, the risk of imminent death of the patient favors administration of LTO+WB. The risk of a possible significant impairment of a fetus in a future pregnancy is estimated by some to be 0.4%.

Yazer MH, Delaney M, Doughty H, et al. It is time to reconsider the risks of transfusing RhD negative females of childbearing potential with RhD positive red blood cells in bleeding emergencies. Transfusion, 2019; 59:3794-3799.

7. IS WHOLE BLOOD SAFE FOR CHILDREN?

Perea LL, Moore K, Hazelton JP. Whole blood resuscitation is safe in pediatric trauma patients: A multicenter study. The American Surgeon. February 13, 2023. [Epub ahead of print]. https://doi.org/10.1177/00031348231157864

Morgan KM, Yazer MH, Triulzi DJ, Strotmeyer S, Gaines BA, Leeper CM. Safety profile of low- titer group O whole blood in pediatric patients with massive hemorrhage. Transfusion. 2021;61(Suppl 1):S8-S14

8. DOES THIS INTERFERE WITH THE ADMINISTRATION OF OTHER BLOOD PRODUCTS OR MEDICATION?

No.

9. CAN A PATIENT RECEIVE COMPONENT THERAPY AFTER RECEIVING O+ WHOLE BLOOD?

Yes.

For further information:

Douglas J. Floccare, MD, MPH, FACEP

Maryland State Air Medical Director, MIEMSS

Medical Director, Maryland State Police Aviation Command

Emergency Physician, University of Maryland Department of Emergency Medicine

Floccare@miemss.org

Office: (410) 706-0880

SYSCOM Helicopter Dispatch: (410) 706-7814