whats the better option for a bleeding patient due to trauma needing blood units , whole blood or packed rbc?

Question

working in a remote area, i have only blood units supplied to my blood bank. no FFP, CRYO, PLTS or other products.
rarely we get trauma patients in need of transfusion. i am trying to wheigh in the pros and cons of whole blood units vs RBC units. my problem with the whole blood is the shorter shelf life.

Answer 1

In trauma patients combinations of stored whole blood, packed cells, colloids & crystalloids are given to maintain blood volume or pressure at adequate levels and haemoglobin at around 7g/dl or haematocrit at 0.25. Opting for a packed RBC is fine. Be aware though that there is a dose dependent correlation between blood product transfusion and outcome in trauma patients. Your priority should be for definitive surgical arrest of haemorrhage from major vessels.Conserve limited supplies of fresh blood until the bleeding is controlled.

Answer 2

Whole blood should only be given when there is also a need for white blood cell replacement. Otherwise packed red cells are the best. There is increased risk of transfusion reaction caused by donor white cells. In a bleeding patient, the object is to maintain oxygen carrying ability which requires maintaining the red blood cell volume, why give them more than they need. In modern blood banking, donor units are divided into several fractions and the idea is to give the patinet specifically what he needs. This is to adress and minimize the risks of transfusion including adverse reactions and infection.

Answer 3

Whole blood transfusion is usually required only when there is excess loss of blood from the patient's body..... otherwise RBC units should be used.