Whole blood vs component therapy

Component therapy (the reconstituted 1-to-1-to-1 from the separate plasma, the platelets and the red cells) is the current standard, supported by the PROPPR trial. It is logistically established, it allows the targeted therapy (the platelets only for the thrombocytopenia, the plasma only for the coagulopathy), and it is universally available. The limitations are the additive volumes (the anticoagulant and the preservative in each component dilute the final concentration), the storage lesion (the platelets lose the function over 5 days, the plasma over 1 year), and the cold storage (the cold blood causes the hypothermia). ^[1] Whole blood (the fresh, the warm, the whole blood from the walking donor or the pre-hospital stock) provides the RBCs, the plasma, the platelets and the clotting factors in the natural ratio, without the additive volumes, without the storage lesion, and at the body temperature. It is the physiological product. The limitations are the logistical complexity (the donor pool, the screening, the typing, the storage), the risk of the TRALI and the haemolysis (if mismatched), the bacterial growth (if stored warm), and the regulatory framework (which varies by the jurisdiction). The military and the pre-hospital services have pioneered the whole blood; the civilian adoption is evolving.