(P-TS-116) Utilization of Frozen Red Blood Cells During CENTCOM Operations, 2008-2014

Given current conflicts and strategic pacing threats around the world, the focus of combat casualty care has shifted to large-scale combat operations (LSCO), where maritime operations will likely play a substantial role in combat casualty care. Due to the logistics of being out at sea, blood supplies may need to be stored for extended periods of time. Frozen red blood cells (RBCs) are stored in glycerin to preserve the RBC membrane, they require deglycerolization prior to use and are referred to as Deglycerolized RBC (DRBC). DRBCs can be stored and prepositioned for up to 10 years. The objective of this study was to describe the usage of DRBC during US combat operations.

Study

Design/Methods:

Patients were eligible to be included in the analysis if they received DRBCs between 2008 and 2014 according to the Armed Service Blood Program (ASBP) database. Subjects were excluded if ASBP data could not be linked to the Department of Defense Trauma Registry (DODTR). The patients who could be linked were described by outcomes, transfusion volumes, and mean laboratory values.

Results/Findings:

Of the 232 study patients, the majority survived (92.7%). The majority of the DRBC transfusions occurred at role 3 levels of care (85.5%). The median (IQR) injury severity score was 20 (11.5, 29). Most patients (63.8%) had a severe injury (abbreviated injury score >2) to the extremities or pelvic girdle. The median [IQR] lab values for study patients were low for base deficit (-3 [-5, 0]), blood gas pH (7.3 [7.3, 7.4]), hematocrit (31.9 [28.2, 36.4]), hemoglobin (10.6 [9.5, 12.0]), while increased for international normalized ratio (1.2 [1.1, 1.4]). The median (IQR) amount of DRBC received was 2 (1, 2) units, where the maximum amount of DRBCs given was 11 units. The median (IQR) total transfusion volume received was 11 (4.5, 22) units.  Patients who only received DRBCs (8.6%) received a low median [IQR] volume of transfusion (1 [1, 2]). The median (IQR) amount of other red-blood-cell-containing products was 4.5 (2, 8) units of RBCs, 0 (0, 0) units of low-titer O whole blood, and 6 (4, 26) units of whole blood (WB).  Two transfusion reactions were recorded. DRBC use on hospital ships and combatant vessels were not identified in this cohort.

Conclusions:

Among patients who received DRBCs, most of the red cells transfused to these patients were from either RBCs or WB. Preparing for the future operating environment requires a multi-pronged approach to blood-based resuscitation of casualties with traumatic injury. DRBCs provide a contingency plan for denied environments; clinical outcomes for the use of DRBC for resuscitation need to be further studied.