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Whole blood vs components: mixed mortality, lower transfusion needs
Whole blood transfusion vs. component therapy for trauma resuscitation in the prehospital and emergency department settings: a systematic review
International Journal of Medicine in Developing Countries · Added 10 November 2026
A PRISMA systematic review of 22 comparative studies (about 95,000 patients) on whole blood versus component therapy for trauma resuscitation found mixed mortality results — survival signals in hypotensive, penetrating and geriatric subgroups but not everywhere — with consistently lower transfusion requirements and comparable or better safety with whole blood.
- Study type
- Systematic review
- Design
- Systematic review (PRISMA 2020, ROBINS-I) of comparative studies
- Participants
- 22 comparative studies, about 95,000 trauma patients
- Main finding
- Survival benefit with whole blood in some studies — hypotensive patients (aOR 0.72 for SBP<90), penetrating injury (RR 0.36), geriatric (OR 0.60) — but no difference in others including one randomised trial; transfusion requirements consistently lower with whole blood; VTE risk lower (OR 0.70)
- Caveat
- Narrative synthesis only due to heterogeneity, and the publishing journal is low-profile — treat the pooled direction with caution
- Bottom line
- Hypothesis-generating
Why it matters in Australia (Medium relevance). Blood products are carried by several Australian services but not most, and the review spans prehospital and ED settings, so it informs the whole-blood-versus-components debate rather than everyday practice.
Learning goal
Weigh the benefits and limitations of prehospital whole blood versus component therapy when resuscitating hypotensive trauma patients.
More
- Topic: Trauma
- Daily scan: 10 November 2026
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