Free
Correspondence  |   October 2012
Whole Blood: More than the Sum of the Parts
Author Affiliations & Notes
  • Andrew D. Pitkin, M.B.B.S., M.R.C.P., F.R.C.A.
    *
  • *University of Florida College of Medicine, Gainesville, Florida.
Article Information
Correspondence
Correspondence   |   October 2012
Whole Blood: More than the Sum of the Parts
Anesthesiology 10 2012, Vol.117, 915-916. doi:10.1097/ALN.0b013e318268ffa0
Anesthesiology 10 2012, Vol.117, 915-916. doi:10.1097/ALN.0b013e318268ffa0
To the Editor: 
Dr. Weiskopf's editorial, “Reconstructing Deconstructed Blood for Trauma,”1 should prompt serious examination of conventional blood banking practices, not just as they pertain to trauma, but also to other areas of patient care that involve significant blood component transfusion. He mentions two small trials in adult cardiac surgery that have had less-than-convincing results,2,3 but he omitted one landmark study in pediatric cardiac surgery. Manno et al.  at the Children's Hospital of Philadelphia, Pennsylvania, compared use of whole blood and “reconstituted” blood (packed erythrocytes, fresh frozen plasma, and platelets) in children undergoing cardiac surgery with cardiopulmonary bypass.4 This study showed that in the highest risk group, children less than 2 yr of age having high complexity surgery, postoperative blood loss in the group receiving reconstituted blood was around twice that of the whole blood group. Very fresh whole blood did not have a significant advantage over whole blood stored for 24–48 h. In addition, they showed that the platelets in reconstituted blood had significantly more abnormal aggregation in response to adenosine diphosphate, epinephrine, and collagen, suggesting that preservation of platelet function may be one reason for the superiority of whole blood in treating the postcardiopulmonary bypass coagulopathy. Lavee et al.  showed a similar effect of whole blood on preservation of platelet function by showing that platelet aggregation as assessed by electron microscopy after cardiopulmonary bypass in adult patients was restored by 1 unit of whole blood to a level equivalent to 8–10 platelet units.5 It is not only patients (of trauma and otherwise) who would benefit from more widespread use of whole blood in terms of clinical outcome and limitation of their exposure to donors. Somewhat counterintuitively, use of whole blood may also help eke out a dwindling blood supply by being substantially more efficient than components, particularly platelets, which may have lost much of their efficacy in the process of being separated and stored apart. It will require effort by clinicians to convince the blood bank community that the whole is more than the sum of the parts.
References
Weiskopf RB: Reconstructing deconstructed blood for trauma. ANESTHESIOLOGY 2012; 116:518–21
Triulzi DJ, Gilmor GD, Ness PM, Baumgartner WA, Schultheis LW: Efficacy of autologous fresh whole blood or platelet-rich plasma in adult cardiac surgery. Transfusion 1995; 35:627–34
Mohr R, Martinowitz U, Lavee J, Amroch D, Ramot B, Goor DA: The hemostatic effect of transfusing fresh whole blood versus  platelet concentrates after cardiac operations. J Thorac Cardiovasc Surg 1988; 96:530–4
Manno CS, Hedberg KW, Kim HC, Bunin GR, Nicolson S, Jobes D, Schwartz E, Norwood WI: Comparison of the hemostatic effects of fresh whole blood, stored whole blood, and components after open heart surgery in children. Blood 1991; 77:930–6
Lavee J, Martinowitz U, Mohr R, Goor DA, Golan M, Langsam J, Malik Z, Savion N: The effect of transfusion of fresh whole blood versus  platelet concentrates after cardiac operations. A scanning electron microscope study of platelet aggregation on extracellular matrix. J Thorac Cardiovasc Surg 1989; 97:204–12