In military combat, massive blood loss is a major cause of death. Having red blood cells (RBCs) available in the military theater at all times is therefore of vital importance. In the past, an inventory of RBCs was difficult to maintain in combat areas because of the unpredictable demand and the limited shelf life of refrigerated stored RBCs. As a result, fresh whole blood (FWB) has been used repeatedly by the US military to resuscitate severely bleeding trauma patients. FWB is blood that is donated by military and hospital personal on site and stored for less than 24 hours at room temperature. Warm FWB has the theoretical advantage of supplying all the appropriate blood components with maximal functionality. However, usage of untested FWB proposes a risk of infectious disease transmission, bacterial contamination, and adverse reactions due to the presence of leukocytes, as well as logistic difficulties in obtaining the appropriate RBCs at the right time. The US military supports transfusion of FWB either when standard blood components are not available or if transfusion of the available blood components are not adequately correcting life treating bleeding.
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