Blood Transfusion from the Military’s Standpoint: Making Last Century’s Standard Possible Today

Abstract

Purpose of Review

The purpose of this review was to evaluate past, present and emerging concepts in transfusion medicine as it pertains to combat casualty care. Transfusion practices have paramount historical significance in military medicine and battlefield care. An understanding of transfusion history during recent wars have helped inform some current practices and must not be forgotten, especially as we define the future of battlefield transfusion as it pertains to the importance and implementation of whole blood.

Recent Findings

The implementation of damage control resuscitation during the recent wars in Iraq and Afghanistan has changed the face of modern transfusion practices in both military and civilian trauma. The value of whole blood has been recognized clinically and is considered the best fluid for hemorrhagic shock; however, despite being readily available during walking blood banks, widespread adoption and standardized availability remain a challenge.

Summary

Transfusion is an essential capability and saves lives on the battlefield. Whole blood, followed by component therapy using the proper ratios, is the best fluid for hemorrhagic shock. There is a growing body of evidence regarding the detrimental effects of crystalloid use in hemorrhagic shock. The timing of blood product transfusion is critically important—minutes matter. Lessons learned in previous wars regarding the value of whole blood transfusion have been rediscovered and should be codified into military and civilian surgical practices.

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