Damage control resuscitation principles advocate utilization of whole blood (WB) based resuscitation to treat shock and coagulopathy in an effort to decrease death from hemorrhage. However, white cells present in whole blood can cause adverse transfusion related events. This Terumo BCT ImuflexWB-SP FDA approved whole blood system was used containing a platelet sparing, leukoreducing filter and reconfigured capability to permit safer and easier WB transfusions for the user environment. To decrease filtration time 500 ml of WB from healthy blood donors was subjected to leukocyte filtration by gravitational, 150 and 300 mmHg forces and then tested. Additional testing then compared filtration at 1 or 4 hours after donation as well as changing the height of filtration from the standard of 85 2 cm (33 inches) to 71 cm (28 inches) to evaluate the effects of time and height on the reduction of platelet aggregation over time. Gravity filtration took 35 3 minutes and produced a consistently leukoreduced (LR) product (0.1106/unit). Filtration at 150 mmHg significantly reduced filtration time to 14 1 minutes (p0.001), but resulted in 1 of 10 units with a residual WBC 5.0106/unit. Increasing pressure to 300 mmHg further reduced the time to 9 0 minutes (p0.001), but caused 4 of 10 units to exceed 5.0106/unit. Platelet recovery decreased from 90 9% using gravity to 84 9% at 150 mmHg and 83 15% at 300 mmHg. Gravity filtration 4 hours after donation at 33 inches height resulted in a slight decrease in the loss of platelet aggregability 24 hours after filtration (when stored at 4 degrees C), without any other changes over the subsequent three weeks in platelet performance compared to non-leukoreduced whole blood and whole blood leukoreduced after 1 hour at 33 inches or 4 hours at 28 inches.
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