Damage Control Resuscitation.

Damage control resuscitation (DCR) is a strategy for resuscitating patients from hemorrhagic shock to rapidly restore homeostasis. Efforts are focused on blood product transfusion with whole blood or component therapy closely approximating whole blood, limited use of crystalloid to avoid dilutional coagulopathy, hypotensive resuscitation until bleeding control is achieved, empiric use of tranexamic acid, prevention of acidosis and hypothermia, and rapid definitive surgical control of bleeding. Patients receiving uncrossmatched Type O blood in the emergency department and later receiving cumulative transfusions of 10 or more red blood cell units in the initial 24-hour post-injury (massive transfusion) are widely recognized as being at increased risk of morbidity and mortality due to exsanguination.

Soluble antigens in plasma allow mismatched transfusion without hemolysis.

Background: Universal plasma is a scarce resource when a massive transfusion protocol has been initiated. Previous studies have reported success using group A plasma in place of the universal plasma, group AB. It is unclear why there are not more reports of hemolytic reactions occurring from this practice.

Optimizing Transfusion Ratios in Massive Transfusion Protocols: An Argument Against the 1:1:1 Dogma and Approach to Trauma Resuscitation.

We believe that the current practice of transfusing red blood cells (RBCs), plasma, and platelets in a 1:1:1 ratio is not optimal in massive transfusion protocols (MTPs) and is based on a simple yet profound misconception regarding the preparation of component blood products. This 1:1:1 approach ignores the additional fluids added for anticoagulation and preservation of the components and assumes that there is a one-size-fits-all ratio that must be used across all types of trauma. In this article, we explain the rationale behind our conclusion with supporting figures and suggest that although the 1:1:1 ratio might be within the range of hemostasis, it falls near the lower cusp of hemostasis, making it less than ideal.

Anti-c (Little c) IgM: An Uncommonly Observed but Expected Phenomenon.

The c-antigen (little c) is part of the Rh blood group system and is found in approximately 80% of the United States population. Anti-c antibody develops in individuals sensitized through previous exposure and is associated with acute and delayed hemolytic transfusion reactions as well as hemolytic disease of the newborn (HDN). Most antibodies produced against Rh antigens are of the immunoglobulin (Ig) G type.

Low titer group O whole blood in emergency situations.

In past and ongoing military conflicts, the use of whole blood (WB) as a resuscitative product to treat trauma-induced shock and coagulopathy has been widely accepted as an alternative when availability of a balanced component-based transfusion strategy is restricted or lacking. In previous military conflicts, ABO group O blood from donors with low titers of anti-A/B blood group antibodies was favored. Now, several policies demand the exclusive use of ABO group-specific WB.

Aminodifluorosulfinium salts: selective fluorination reagents with enhanced thermal stability and ease of handling.

Diethylaminodifluorosulfinium tetrafluoroborate (XtalFluor-E) and morpholinodifluorosulfinium tetrafluoroborate (XtalFluor-M) are crystalline fluorinating agents that are more easily handled and significantly more stable than Deoxo-Fluor, DAST, and their analogues. These reagents can be prepared in a safer and more cost-efficient manner by avoiding the laborious and hazardous distillation of dialkylaminosulfur trifluorides. Unlike DAST, Deoxo-Fluor, and Fluolead, XtalFluor reagents do not generate highly corrosive free-HF and therefore can be used in standard borosilicate vessels.

The ratio of fibrinogen to red cells transfused affects survival in casualties receiving massive transfusions at an army combat support hospital.

Background: To treat the coagulopathy of trauma, some have suggested early and aggressive use of cryoprecipitate as a source of fibrinogen. Our objective was to determine whether increased ratios of fibrinogen to red blood cells (RBCs) decreased mortality in combat casualties requiring massive transfusion.

Methods: We performed a retrospective chart review of 252 patients at a U.