A study funded by the Department of Defense, managed by NTI, and published in the Journal of Trauma and Acute Care Surgery (Vol. 83, No. 3) identifies a problem with using filtered whole blood for hemostatic resuscitation—it exhibits decreased functional clotting capacity and thrombin generation.
Henry Magill Cryer, MD, PhD, the study’s principal investigator, sought to explore how the apparent benefits of using whole blood for resuscitation might be realized more broadly than on the battlefield, where a walking donor base is able to supply fresh whole blood for use in trauma surgeries. The purpose of the study was to characterize the hemostatic capacity of whole blood during 35 days of storage, comparing non-leukoreduced whole blood to whole blood leukoreduced with a standard filter.
“We found that unfiltered refrigerated whole blood maintained global coagulation potential for 35 days of storage, while filtered whole blood had significantly decreased maximum clot strength, rate of clot growth, and maximum thrombin generation at various timepoints of storage,” the investigators wrote. Standard leukofiltration practices lead to reduced functional clotting capacity, in part due to the incidental removal of platelets during leukofiltration.
The researchers next intend to study the clotting capacity of whole blood leukoreduced using a special platelet-sparing filter to determine whether, and for how long, clotting capacity might be preserved. “The platelet-sparing filter could be the key to bringing the benefits of whole blood to civilian trauma patients,” said Anaar Eastoak-Siletz, MD, another study investigator, “but given the findings above, hemostatic capacity during storage must first be defined.
[This work was funded by the Office of the Assistant Secretary of Defense for Health Affairs through the Defense Medical Research and Development Program and managed by the National Trauma Institute under the prime award #W81XWH-15-2-0039.]
-by Pam Bixby, Pam@NatTrauma..org