Not all blood programs are created equal. For Fresh Whole Blood (FWB) transfusions in an operational environment,
a framework for characterization of programs can be considered either “prospective” or “contingency.”
Prospective programs are the planned use of walking blood banks with pre-screened donor pools. These programs benefit from the ability to not only confirm blood types and anti-A/anti-B titers (and maintain accurate records), but also to have at least a minimum of pre-screening for Transfusion Transmitted Diseases (TTD). TTDs include: HIV, hepatitis B and C, malaria, syphilis, and others. Examples of prospective military programs include the Norwegian Special Operations Forces (NORSOF), and US Army Rangers’ transfusion programs.
Contingency programs, on the other hand, can be considered those situations where a medic may have the necessary training and equipment, but due to operational considerations (most likely a very limited known donor pool), may not have the ability to pre-screen the potential donors. This would necessitate both rapid typing, and screening for TTDs in the field, prior to establishing an acceptable donor pool.
By far, the most dangerous complication of a FWB transfusion is type mismatch. Though rare with adequately trained providers, this could lead to a potentially fatal reaction. The threat of TTDs, on the other hand, looms as the most ominous reason not to utilize field FWB transfusions. There are situations, however, where a critical patient requires a transfusion to treat or prevent hemorrhagic shock. In these cases, a rapid screening tool is required to greatly reduce the risk of TTDs.
The Trauma Hemostasis and Oxygenation Research (THOR) Group has recently published an evidence-informed emergency donor panel questionnaire and triage tool that can be used for screening potential donors in contingency situations. In the absence of data or solid recommendations in the literature, this screening tool is a valuable reference to review, print and have in your kit bag to help with identifying the most appropriate potential FWB donors in austere practice environments. Read it – use it!