Evaluated the use of low-titer group O Whole Blood (LTOWB) in hemorrhagic shock patients for emergency transfusion, at Cristo Redentor Hospital, a specialized trauma hospital in South Brazilian.

A retrospective, single-center study of two years of LTOWB experience (2021–2023). LTOWB were produced at Hemotherapy Service HNSC, with low-titer group O (IgG <200), man blood donor, RhD positive, HbS negative. Evaluated data from a type of trauma, number of LTOWB used, clinical outcome, survival after 48 hours, and laboratory data. Also, was performed search in electronic databases for studies published.

In two years 208 LTOWB units were transfused in 149 patients (134 male [90%]). Regarding clinical outcomes, 56 deaths, 34 were in less than 48 hours. Road traffic injuries (n = 66) and gunshot wounds (n = 52) were the most frequent type of trauma in hemorrhagic shock. After LTOWB was used, 90 patients continue transfusion with conventional component therapy (packed red blood cells, plasma, platelets, and cryoprecipitate). The number of LTOWB units transfused for each patient was variable to 1 unit (n = 90), 2 units (n = 43), 3 units (n = 4), 4 and 6 units (n = 1). Concerning ABO and RhD type, O-positive was the most frequent (n= 60) followed by A-positive (n = 47), only 17 patients were RhD negative. The lowest hemoglobin after transfusion LTOWB and components was 4.8 g/dL (median = 10.8 g/dL).

In trauma, the historical scenario expected the highest number of male patients, then using O-positive whole blood is a safe choice considering the number of O-negative blood units is lower. Some studies showed the use of LTOWB was associated with improved survival in shock hemorrhagic patients, in our study 62.4% of patients had a hospital discharge.

LTOWB is an interesting alternative use in trauma resuscitation, the experience of two years of using LTOWB at Cristo Redentor Hospital showed a safety protocol and true agility in managing hemorrhagic trauma patients.