The LT-O Whole Blood CONTROVERSY

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Dr. Chapa (0:37)

Hello, podcast family. This is Michael, the producer of Dr. Chapa's podcast. The siren you're about to hear is part of the show. If you're driving, don't be alarmed. Now on with the show.

Just recently, we had a pretty severe, pretty morbid maternal trauma at our institution, and it shook everybody up.

Very thankful for our first responders. I definitely couldn't do it, and they do a great job to get patient critical care as she is in transport to any facility.

But in this episode, we're going to tackle a real world clinical issue that was discussed even with this recent maternal trauma. The issue is this, in a patient who is of reproductive age and is undergoing massive hemorrhage, should the use of low titer, O-positive blood be used for transfusion purposes for resuscitation if it's a life and death emergency, knowing of course that there is a real risk of future alloimmunization or isoimmunization and potential harm to a future pregnancy? Now, I know what you're thinking, I know what you're thinking, because I think it too.

Whatever, in case of a massive hemorrhage, give the patient some blood. But this is very controversial now. We actually covered this. If you remember, you've been following the podcast for some time. We actually have an episode on low titer O-positive whole blood transfusion in reproductive age women. We've covered this in the past, and it's back. Just let you know that we are definitely on the forefront of topics here on the show. This was at least two years ago. You can go back and look at the archive. So here's where we're going to balance, and here's what we're going to discuss in this episode. It's actually fascinating. So watch this timeline here.

In the summer of 2026, in July, the American College of Surgeons, their Committee on Trauma, that is the Acs-Cot, updated their stance regarding the routine prehospital and emergency use of low-titer, O-positive whole blood for trauma patients in severe hemorrhagic shock. We get that. Remember, that's in July of 2026 Now, I'm going to read you the key excerpts there. Let me just give you the spoiler. Of course, as trauma surgeons and emergency care providers are like, hey, I'm giving you whatever you need to keep you alive. Makes sense. However, just two months after that, in September of 2026, published as a clinical perspective in the Green Journal, Jacobs et al. and an international team of experts, by the way, released a perspective titled, quote, RHD positive whole blood for patients with reproductive potential after two randomized trials of prehospital trauma resuscitation, end quote. This paper urges the medical community to pump the brakes on whole blood that is low titer positive RH factor. Now, let me explain. Well, if you're like, what are we talking about here? Don't we do component therapy? Yes, we do packed red blood cells and then platelets, and then we do FFP.

But the reason that during resuscitation or massive obstetrical hemorrhage, we do a one to one to one ratio of those three is because we're trying to constitute what? Whole blood. That was the original parkland UT Southwestern trauma and maternal resuscitation. I think if packed red blood cells back the day, you gave them O-negative whole blood and in a pinch, O-positive whole blood. Now, just to be clear, we're talking about in this episode non-pregnant females of reproductive potential, right? So these are non-pregnant. But the same applies even during a pregnancy. The point is, if you have, all of that you have is low titer O-positive blood, is that still valid? Now, again, no one's going to argue you got to do what you got to do. But it's interesting from these two different statements here. One is a true committee opinion from a professional medical organization. The other is a clinical perspective by leading experts. And while they're looking at the same glass that contains fluid, one definitely sees the glass as half full. The other definitely sees the glass as half empty. It really is a very interesting take on the same subject. Let me be very clear where I stand. If this was my wife, my daughter, my family member, my close friend who's having a severe hemorrhage and she is of reproductive potential, give her whatever you need to do to keep her alive. And we will worry about the consequences later because I'd rather have her alive than not. Now that's just me. But this is a real issue, especially from the MFM side, when we have to deal with maternal fetal immunization and hemolytic disease with the fetus and newborn. So is this an issue?