The decision on what blood product to use depends on multiple factors: clinical status of the patient, supply, resupply, and the ability to activate the WBB. WBB activation and other resuscitation nuances are further discussed in the DCR32 and WB Transfusion1 CPGs, but in general, the WBB is reserved for situations where there are substantial supply limitations, or the senior surgeon believes the casualty’s survival requires fresh whole blood from a WBB.

The choice to use Whole Blood from a WBB versus NBB-TSWB versus NBB-LTOWB should be based on the recipient’s blood type (and ability to determine blood type), blood product availability, and the urgency of the situation. The below guidance is on the appropriate use of Type Specific Whole Blood to optimize patient outcomes while minimizing risks associated with ABO mismatch. Choices are numbered in order of preference.

- If the patient’s blood type is unknown à 1) NBB-LTOWB or 2) WBB-LTOWB. If the patient can be accurately blood typed and they are group A, then can switch to Type A NBB-TSWB or WBB-TSWB once blood type is determined. *
- If the patient has confirmed Type A blood à 1) Type A NBB-TSWB or 2) NBB-LTOWB or 3) WBB-TSWB or 4) WBB-LTOWB.*
- If the patient has confirmed Type O blood à 1) NBB-LTOWB or 2) WBB-LTOWB or 3) WBB-TSWB. Only blood type O is acceptable to be transfused to Type O patients.
- If the patient has either confirmed Type B or Type AB blood à 1) NBB-LTOWB or 2) WBB-LTOWB or 3) WBB-TSWB.*

*There is a theoretical, unproven risk of hemolysis when transfusing ABO group-specific blood following large volume LTOWB resuscitations that started with the misinterpretation of outdated and unreliable laboratory data during the Korean war, however, contemporary data do not justify a change in the above recommendations.33 This underscores the importance of timely and accurate transfusion documentation.