Whole blood (WB) is the preferred resuscitation fluid for bleeding patients.1 As of 2025, there are currently two types of WB available in the deployed setting: (1) WB from a Walking Blood Bank that is either ABO-group specific or Low-Titer O Whole Blood (LTOWB) and (2) Blood donor center produced LTOWB that is tested according to the FDA standards and shipped to deployed locations. Up until 2016, the only WB transfused on the battlefield was type specific warm fresh whole blood (FWB) from Walking Blood Banks (WBB). In April 2016, the Armed Services Blood Program (ASBP) started to deliver fully tested LTOWB to forward deployed environments. Since then, LTOWB has become the transfusion product of choice for the initial resuscitation of hemorrhaging causalities. The adoption (or re-adoption, see below) of LTOWB has also occurred in civilian trauma centers with nearly 300 trauma hospitals in the U.S. using LTOWB.1,35 LTOWB is limited in its availability. Adopting Type A WB will increase the donor pool and create a more resilient blood supply for current and future operations.2

Approximately 45% of the U.S. population is group O and 40% is group A. Therefore, having ASBP produced group A WB available in the deployed setting for combat casualties will significantly increase the availability of stored WB in the deployed environments. Given the concerns regarding future large scale combat operations, it can be anticipated that there will be a shortage of LTOWB. Therefore, the intent of this CPG is to provide guidance on the expanded use of type specific, particularly Type A WB provided by the ASBP to forward deployed locations. This is a new practice for the DoD’s deployed trauma system and is being adopted by the ASBP and the Joint Trauma System (JTS) in anticipation of blood shortages in the future and for contingency planning. This JTS-ASBP CPG is meant to inform, educate and guide on the expanded practice of including ASBP provisioned Type A Whole Blood to the deployed environment.

The ASBP is the official blood program of the U.S. Military. The ASBP is responsible for providing quality blood products to Service Members and their families all around the world. Their primary mission is to support deployed operations, but the ASBP also supplies blood to Military Treatment Facilities (MTFs) in Continental U.S. (CONUS) and outside the Continental U.S (OCONUS). The ASBP blood donor centers are FDA compliant. In the U.S., the other nationally regulated blood product sources are the American Red Cross, the members of the American Blood Centers, and other hospitals and small blood collectors. Other nations have national blood centers as well, but the U.S. is one of the few countries with a dedicated military blood program that exclusively provides full spectrum blood services for the military.

The Armed Services Blood Program supplies Combatant Commands (CCMDs) with blood, sourced from volunteer donors. Seasonal variability and a high demand for LTOWB influence supply and distribution strategies. There is a potential for lack of LTOWB supply to meet future demand signals based on the operational activities in the CCMDs. Augmenting the blood supply by expanding the procurement and use of group A WB can mitigate risk of lack of blood availability. Additionally, since 40% of the U.S. population is group A– expanding the ASBP inventory to include group A whole blood that has been approved by the ASBP or another nation’s National Blood Bank (NBB) will improve whole blood supply to the CCMDs.