CHICAGO (October 24, 2007) -- Combat physicians in war-torn areas like Iraq and Afghanistan may be able to accurately predict which casualties require massive blood transfusions (MT), and thereby increase a soldier's chances of survival, according to research published in the October issue of The Journal of the American College of Surgeons. The study found that the presence of a combination of three variables -- assessed immediately upon arrival at the combat support hospital -- is highly predictive of which soldiers will need MT, thus allowing physicians to mobilize the necessary resources to transfuse large amounts of blood. The three variables are hemoglobin 11g/dL, International Normalized Ratio > 1.5, and a penetrating injury mechanism such as those caused by improvised explosive devices (IEDs) or high-powered weapons.
Hemorrhage (blood loss) is the leading cause of death on the battlefield. Severely injured patients require MT to restore adequate delivery of oxygen to the body. "The sooner we know that a solider needs a massive blood transfusion, the better," said Martin A. Schreiber, MD, FACS, chief of trauma at Oregon Health & Science University, Portland. "Since we have limited access to blood products in combat hospitals and we rely heavily on walking blood banks, it is crucial to be able to mobilize these precious resources early after patients are injured."
Identifying donors and then testing their blood for viruses like hepatitis C and HIV can take up to one hour, a critical period of time in a severely injured patient.
This retrospective cohort analysis included 558 combat victims treated at two combat support hospitals in Iraq. Patients who required MT (n=247), defined as delivery of 10 units of a combination of stored red blood cells and fresh whole blood in the first 24 hours after injury, were compared with patients who did not (n=311). Potentially predictive variables studied were age, gender, mechanism of injury
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