Trauma patients have a severe risk of hemorrhagic shock, and managing their platelet count is crucial for their survival. In the 1970s, the transfusion community stopped using whole blood to support hemostasis in trauma patients and focused on component therapy transfusing fresh-frozen plasma, platelets, and packed red blood cells (RBCs) in a 1:1:1 ratio. However, the separated components do not deliver the same proportion of coagulation factors or platelet counts. To better understand the differences between cold-stored whole blood and ratios of blood components in trauma patients, researchers retrospectively analyzed data from four cohorts. The first cohort included 1292 patients at the University of Maryland Shock Trauma (collected 2002-2010) who received at least one unit of uncrossmatched group O RBCs in the first hour of care. The second and third cohorts were comprised of patients from the pragmatic randomized optimal plasma and platelet ratios trial (N=35 and N=34; collected 2012-2014) and included 1:1:1 and 1:1:2 ratios of plasma, platelets and RBCs transfused within one hour of admission. The fourth cohort included 59 trauma patients (collected 2019-2020) who received at least three units of low-titer group O whole blood (LTOWB) within the first 24 hours after trauma. All trauma patients were severely injured with first mean platelet counts of 204-228 K/µ and subsequent platelet counts about 100 K/µ lower. However, platelet counts of patients transfused with LTOWB and a 1:1:1 ratio of blood components were higher than patients transfused with a 1:1:2 ratio. These data support transfusing LTOWB or a 1:1:1 ratio of blood components in severely injured, hemorrhagic patients.
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