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


Whole-blood transfusion for the treatment of hemorrhagic shock and coagulopathy after injury has a long history in military medicine since World War I. However, whole blood was replaced by component products and an overreliance on crystalloid resuscitation in civilian trauma centers for the last century. Within the last decade, the innovation of LTOWB (low-titer group O whole blood) resulted in a resurgence of WB (whole blood) use in trauma and rapidly evolving change in the paradigm of hemostatic trauma resuscitation. 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 hemorrhagic 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 hemorrhagic 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

Incorporation of LTOWB in both hospital and prehospital protocols facilitates rapid and balanced hemostatic resuscitation, which has been shown to decrease morbidity and mortality after injury. LTOWB transfusion is, therefore, already considered the standard of care in at least 70 high-volume civilian trauma centers across the United States, and ongoing trials are also investigating the expansion of LTOWB in the prehospital setting whereby hemostatic resuscitation is initiated as close to the time of injury as possible.

Click the links below to read more about the evidence supporting the benefits of LTOWB.