Innovations in blood and blood products for adult trauma patients

July 12, 2019

Exciting new developments in blood and blood products at Mayo Clinic's campus in Rochester, Minnesota, will have a direct and positive impact on patients transferred from trauma centers throughout southern Minnesota.

Mayo Clinic has a long history of blood and blood product innovation, including the unique availability of packed red blood cells in 1989 and becoming the first medical center worldwide to carry thawed plasma in 2009. In keeping with that tradition, Mayo Clinic has implemented several novel blood and blood product applications over the past few years. The following explains recent advances and their significance.

Universal group A plasma

Mayo Clinic has moved from use of blood group AB as the universal plasma to use of group A plasma for adult trauma patients.

Why it's significant

Shifting to a common plasma from the rarer AB — found in only 4% of the U.S. population, according to the American Red Cross — will increase plasma availability in hospital and medical transport settings, says Martin D. Zielinski, M.D., a trauma surgeon at Mayo Clinic's campus in Minnesota. Group A plasma use also saves AB for other purposes, and its use should increase rural area liquid plasma availability. Dr. Zielinski indicates he and colleagues have successfully tested group A plasma in group O recipients, as reported in the January 2013 issue of the Journal of Trauma and Acute Care Surgery.

Cold whole platelets

Whole platelets are now kept in cold storage at Mayo Clinic.

Why it's significant

Platelet function is improved with cold storage, according to Dr. Zielinski, who offers a parallel with home cooking. "If you left a steak on the counter for five days, it's probably not going to taste very good compared with putting it in the refrigerator," he says.

As with steak, refrigeration will increase platelet shelf life, which he anticipates will be up to 10 to 15 days, reducing the need for disposal. Platelet serviceable life improvement, in turn, will expand availability for patients.

Cold whole blood (CWB)

Mayo Clinic became the first U.S. medical center to use CWB in the prehospital setting in October 2015, still a rarity among medical facilities.

"Whole blood's been around forever, but has made a resurgence," says Scott Zietlow, M.D., a general surgeon and chair of the Mayo Clinic Medical Transportation System board of directors at the Rochester campus. "It's not simple to pull off, which is why not everybody does this. It's hard to manufacture, especially in the field in helicopters. You need a great relationship with your blood bank."

CWB is available to patients transferred to Mayo Clinic's Rochester campus by helicopter and critical care ground transport.

Why it's significant

CWB lasts 21 days and exposes patients to one donor, reducing infection.

Whole blood is also superior to crystalloid, says Dr. Zielinski, urging trauma professionals to reduce crystalloid usage due to preservatives, which can be detrimental to patients. "When somebody's hemorrhaging to death, they are not hemorrhaging plasma or crystalloid, but blood: true, whole blood," he says. "Whole blood, ultimately, is likely to save more lives."

With these new advances, southern Minnesota trauma centers can have confidence in Mayo Clinic's careful blood and blood product usage monitoring. All blood products administered to patients are heavily scrutinized for bacteria and viruses. Waste reduction also is an important goal with these products, such as returning unused plasma back to general hospital use after day three.

Future directions: Warm fresh whole blood (WFWB)

Until recently, with blood separated into componentry, WFWB use had waned outside of the armed forces, according to a March 2016 case report published in the Turkish Journal of Trauma and Emergency Surgery. Mayo Clinic hopes to one day utilize WFWB, says Dr. Zielinski. One of the most challenging issues with WFWB use is the logistics of immediate availability of blood, which the military has accomplished with on-base blood banks.

WFWB use, involving transfusion from patient to patient, is not without risk. Overall, however, use of WFWB provides 8% benefit to mortality; for example, WFWB may allow a patient to survive, yet contract hepatitis B via transfusion. To mitigate — yet not eliminate — risk, Dr. Zielinski says that ultimately to ensure the best possible patient outcome a rapid detection is needed, such as a color-changing indicator used by the military and analogous to a pregnancy test.

WFWB will also impact mortality. A retrospective study published in the Journal of Trauma and Acute Care Surgery in April 2009 found that 30-day patient survival after hemorrhagic shock may be improved with WFWB use.

Other WFWB benefits include potentially fewer donor exposures, diminished blood loss and decreased transfusion requirements, according to a January 2011 study published in Transfusion.

"The ability to transfer blood within an hour can transform resuscitation," says Dr. Zielinski.

For more information

Why type AB blood is so important. American Red Cross.

Zielinski MD, et al. Emergency use of prethawed Group A plasma in trauma patients. Journal of Trauma and Acute Care Surgery. 2013;74:69.

Kendigelen P, et al. Should warm fresh whole blood be the first choice in acute massive hemorrhage in emergency conditions? Turkish Journal of Trauma and Emergency Surgery. 2016;22:195.

Spinella PC, et al. Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. Journal of Trauma and Acute Care Surgery. 2009;66:S69.

Jobes D, et al. Toward a definition of "fresh" whole blood: An in vitro characterization of coagulation properties in refrigerated whole blood for transfusion.Transfusion. 2011;51:43.