There are risks associated with the use of FWB, including but not limited to increased risk of transfusion-transmitted infections (e.g., HIV, hepatitis B/C, syphilis), and an increased risk of clerical errors leading to major mismatch when ABO-identical WB is provided, due to the potentially chaotic conditions during which FWB is requested.
Additionally, field conditions are inherently unsanitary and are presumed to increase the risk of bacterial contamination of the blood. Recent history with approximately 10,000 FWB transfusions to U.S. personnel during OIF/OEF have resulted in one Hepatitis C (HCV), one Human T-Lymphocyte Virus (HTLV) seroconversion, and one fatal case of transfusion-associated graft-versus host disease that was potentially due to a FWB transfusion.4 FWB is not FDA-approved and is not intended or indicated for routine use. It is NOT appropriate, as a matter of convenience, to use FWB as an alternative to more stringently controlled blood products for patients who do not have severe, immediately life-threatening injuries. FWB is to be used only when other blood products cannot be delivered at an acceptable rate to sustain the resuscitation of an actively bleeding patient, when specific stored products are not available (e.g., SWB, RBCs, FFP, PLTs, Cryo), or when stored components are not adequately resuscitating a patient with an immediately life-threatening injury. FWB should not routinely be collected from pre-screened donors as a way to maintain a routine inventory of WBB-SWB products. In other words, the use of WBB for collection of FWB is for emergency use only. It should be noted that studies of FWB donors have not documented significant decrements in military-relevant task performance following donation. Thus, concerns that FWB collections will adversely affect mission outcomes have not been substantiated and should not preclude WBB activation when conditions for FWB use are met.18
In patients receiving LTOWB (SWB or FWB), every effort should be made to obtain a pre-transfusion blood sample in order to establish the original blood group. If blood samples are obtained after transfusion with LTOWB, it may be impossible to definitively establish a patient’s blood group with the equipment available in the deployed setting. As a result, patients of unknown blood group receiving LTOWB will continue to receive LTOWB or group O RBC units for their acute transfusion requirements for up to a month following admission. This can deplete inventories of LTOWB and group O RBCs.