In 2022 Annals of Surgery published an article that sparked the debate on the use of Whole Blood in resuscitation of bleeding trauma patients. In this article you can learn more about what LTOWB is and why it might be the preferred resuscitation fluid of the future.

The new study identified a significant mortality benefit with the use of cold-stored Whole Blood (WB) compared to Blood Component Therapy (BCT) in haemostatic resuscitation of major bleeding. In fact, it concluded that compared to BCT, the use of cold-stored Whole Blood was associated with a 48% reduction in mortality in trauma patients.

The Innovation of LTOWB (low-titer group O whole blood)

Whole-blood transfusion for the treatment of haemorrhagic shock and coagulopathy after injury has a long history in military medicine since World War I. But whole blood has been replaced by component products and crystalloid resuscitation in civilian trauma centers for the last century.

However, wwithin the last decade, the innovation of LTOWB (low-titer group O whole blood) has resulted in a resurgence of WB (whole blood) use in trauma care. For example, in 2014 the committee on Tactical Combat Casualty Care recommended FWB (fresh whole blood) as the preferred resuscitative product for DCR (Damage Control Resuscitation) in haemorrhagic shock.

LTOWB is unseparated blood, collected from a donor with “low” IgM and/or IgG anti-A and anti-B and can either be stored or given fresh (within 8-24 hours).

LTOWB use in trauma and haemorrhagic shock has proven advantages over component therapy:

  • It is less likely to cause a severe transfusion reaction
  • It contains less anticoagulants and additives
  • It causes less dilutional coagulopathy
  • It is faster and easier to deliver and is more cost effective to produce

Whole Blood vs Blood Component Therapy

At the 142nd Annual Meeting of the American Surgical Association a new study on Whole Blood (WB) vs Blood Component Therapy (BCT) for transfusion in trauma patients was presented.

This study was conducted as a multicenter, prospective-observational study of patients who received WB vs BCT during their initial trauma resuscitation.

A total of 1,623 trauma patients were included and of the 1,623 patients, 1,180 (73%) received at least one unit of WB while 443 (27%) received only BCT.

The researchers saw that patients who received WB were 9% less likely to experience a bleeding complication and were 48% less likely to die than those who received BCT alone.

In conclusion the use of whole blood transfusion resulted in a 48% reduction in mortality in trauma patients compared with standard blood component therapy.

Ongoing trials on Whole Blood will bring further evidence 

There is no doubt that the already published results support the use of Whole Blood in Emergency Medical Services and the Military, but even more trials are being conducted.

In December 2022 the NHS, the National Health Services in the UK, launched the trial, SWIFT, on whole blood transfusions in 10 air ambulances. Over the next two years the SWIFT trial will gather further evidence on Whole Bloods potential to improve civilian and military trauma care.


Annals of Surgery
JAMA Surgery



The ˚M Warmer System

The ˚M Warmer is a portable blood and IV fluid warming device optimal for both prehospital and hospital use as it is small, simple to use and has extremely efficient warming capabilities (150 ml/min).