Injured recipients of low-titer group O whole blood have similar clinical outcomes compared to recipients of conventional component therapy: A single-center, retrospective study

Transfusion. 2021 Jun;61(6):1710-1720. doi: 10.1111/trf.16390. Epub 2021 Apr 3.

Abstract

Introduction: Low-titer group O whole blood (LTOWB) is being increasingly transfused to injured patients. This study evaluated a range of clinical outcomes to determine if receipt of LTOWB predisposed recipients to worse outcomes compared to recipients of conventional component therapy (CCT).

Methods: A retrospective analysis of trauma patients who received at least 3 units of LTOWB (LTOWB group) versus those that received at least 3 units of RBCs, 1 unit of plasma and 1 unit of platelets but no LTOWB (CCT group) during the first 24 h of their admission was performed. Causal treatment effects were explored using propensity score matching (PSM) and coarsened exact matching (CEM). Important clinical outcomes were evaluated.

Results: There were 165 CCT and 155 LTOWB recipients eligible for matching. PSM and CEM reduced covariate imbalances between the CCT and LTOWB groups, with the exception that males remained over-represented in the LTOWB group due to the hospital's former resuscitation policy of not administering RhD-positive LTOWB to females <50. In both of the matched analyses, the LTOWB group received a median of 4 LTOWB units. There were no significant differences in 6-, 24-h mortality or 30-day mortality between groups, nor were there differences in the frequency of other clinical outcomes such as acute kidney injury, sepsis, venous/arterial thromboembolism; delta MODS was lower for the LTOWB recipients in the exact match group.

Conclusion: In both matched analyses, administration of a median of four LTOWB units did not result in a different frequency of major clinical outcomes including mortality.

Keywords: adverse event; conventional components; low titer group O whole blood; mortality; safety; transfusion; trauma.

Publication types

  • Comparative Study

MeSH terms

  • ABO Blood-Group System / blood
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Transfusion* / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Resuscitation / methods
  • Retrospective Studies
  • Wounds and Injuries / blood
  • Wounds and Injuries / therapy*
  • Young Adult

Substances

  • ABO Blood-Group System