The Evolution of Transfusion Therapy in Trauma

  • Colin H. Murphy
  • John B. Holcomb
  • John R. HessEmail author


Transfusion has played a critical role in the history and development of trauma care since the first blood bank was established 100 years ago. Rapid access to a full range of blood products saves lives. Initial treatment of massive hemorrhage is formulaic, attempting to replace lost blood volume, oxygen carrying capacity, and hemostatic activity simultaneously. This can be accomplished with whole blood, but components are currently more widely available and appear to be satisfactory when used in balanced ratios. Laboratory-guided resuscitation should be initiated when bleeding slows and is possible with viscoelastic testing or conventional laboratory tests.


Injury Trauma Hemorrhage Coagulopathy Acute coagulopathy of trauma Trauma-induced coagulopathy Transfusion Massive transfusion Resuscitation Hemostatic resuscitation Damage control resuscitation Balanced resuscitation 


  1. Armand, R., & Hess, J. R. (2003). Treating coagulopathy in trauma patients. Transfusion Medicine Reviews, 17, 223–231.CrossRefGoogle Scholar
  2. Bickell, W. H., Wall, M. J., Pepe, P. E., Martin, R. R., Ginger, V. F., Allen, M. K., et al. (1994). Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. The New England Journal of Medicine, 331, 1105–1109. Scholar
  3. Borgman, M. A., Spinella, P. C., Perkins, J. G., Grathwohl, K. W., Repine, T., Beekley, A. C., et al. (2007). The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. The Journal of Trauma, 63, 805–813. Scholar
  4. Brohi, K., Singh, J., Heron, M., & Coats, T. (2003). Acute traumatic coagulopathy. The Journal of Trauma, 54, 1127–1130. Scholar
  5. Cannon, J. W., Khan, M. A., Raja, A. S., Cohen, M. J., Como, J. J., Cotton, B. A., et al. (2017). Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. Journal of Trauma and Acute Care Surgery, 82(3), 605–617. Scholar
  6. Chandler, M. H., Roberts, M., Sawyer, M., & Myers, G. (2012). The US military experience with fresh whole blood during the conflicts in Iraq and Afghanistan. Seminars in Cardiothoracic and Vascular Anesthesia, 16, 153–159. Scholar
  7. Cohen, M. J., Kutcher, M., & Redick, B. (2013). Clinical and mechanistic drivers of acute traumatic coagulopathy. Journal of Trauma and Acute Care Surgery, 75, S40–S47. Scholar
  8. Cosgriff, N., Moore, E. E., Sauaia, A., Kenny-Moynihan, M., Burch, J. M., & Galloway, B. (1997). Predicting life-threatening coagulopathy in the massively transfused trauma patient: Hypothermia and acidoses revisited. The Journal of Trauma, 42, 857–861.CrossRefGoogle Scholar
  9. Dutton, R. P., Mackenzie, C. F., & Scalea, T. M. (2002). Hypotensive resuscitation during active hemorrhage: Impact on in-hospital mortality. The Journal of Trauma, 52(6), 1141–1146.CrossRefGoogle Scholar
  10. Holcomb, J. B., del Junco, D. J., Fox, E. E., Wade, C. E., Cohen, M. J., Schreiber, M. A., et al. (2013). The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: Comparative effectiveness of a time-varying treatment with competing risks. JAMA Surgery, 148(2), 127–136. Scholar
  11. Holcomb, J. B., Jenkins, D., Rhee, P., Johannigman, J., Mahoney, P., Mehta, S., et al. (2007). Damage control resuscitation: Directly addressing the early coagulopathy of trauma. The Journal of Trauma, 62(2), 307–310. Scholar
  12. Holcomb, J. B., & Pati, S. (2013). Optimal trauma resuscitation with plasma as the primary resuscitative fluid: The surgeon’s perspective. Hematology American Society of Hematology Education Program, 2013, 656–659. Scholar
  13. Holcomb, J. B., Tilley, B. C., Baraniuk, S., Fox, E. E., Wade, C. E., Podbielski, J. M., et al. (2015). Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA, 313(5), 471–482. Scholar
  14. Holcomb, J. B., Wade, C. E., & The Trauma Outcomes Group. (2011). Defining present blood component transfusion practices in trauma patients: Papers from the Trauma Outcomes Group. The Journal of Trauma, 71(2 Suppl 3), S315–S317. Scholar
  15. Kendrick, D. B. (1964). Blood program in World War II. Arlington: Office of the Army Surgeon General.Google Scholar
  16. Landsteiner, K. (1900). Zur Kenntnis der antifermentativen, lytischen und agglutinierenden Wirkungen des Blutserums und der Lymphe. Centralblatt f. Bakteriologie, Parasitenkunde u. Infektionskrankheiten, 27, 357–362.Google Scholar
  17. Lee, R. I., & Vincent, B. (1914). The coagulation of normal human blood, an experimental study. Archives of Internal Medicine, 13, 398–425.CrossRefGoogle Scholar
  18. MacLeod, J. B., Lynn, M., McKenney, M. G., Cohn, S. M., & Murtha, M. (2003). Early coagulopathy predicts mortality in trauma. The Journal of Trauma, 55, 39–44. Scholar
  19. Moore, H. B., Moore, E. E., Liras, I. N., Gonzalez, E., Harvin, J. A., Holcomb, J. B., et al. (2016). Acute fibrinolysis shutdown after injury occurs frequently and increases mortality: A multicenter evaluation of 2,540 severely injured patients. Journal of the American College of Surgeons, 222, 347–355. Scholar
  20. Neal, M. D., Brown, J. B., Moore, E. E., Cuschieri, J., Maier, R. V., Minei, J. P., et al. (2014). Prehospital use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced incidence of trauma-induced coagulopathy. Annals of Surgery, 260(2), 378–382. Scholar
  21. Novak, D. J., Bai, Y., Cooke, R. K., Marques, M. B., Fontaine, M. J., Gottschall, J. L., et al. (2015). Making thawed universal donor plasma available rapidly for massively bleeding trauma patients: Experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial. Transfusion, 55, 1331–1339. Scholar
  22. Ottenberg, R., & Kaliski, D. J. (1913). Accidents of transfusion, their prevention based on preliminary blood examination: Based on a preliminary experience of 128 transfusions. JAMA, 61, 2138.CrossRefGoogle Scholar
  23. Pati, S., Potter, D. R., Baimukanova, G., Farrel, D. H., Holcomb, J. B., & Schreiber, M. A. (2016). Modulating the endotheliopathy of trauma: Factor concentrate versus fresh frozen plasma. Journal of Trauma and Acute Care Surgery, 80(4), 576–584. Scholar
  24. Robertson, O. H. (1918). Transfusion with preserved red blood cells. British Medical Journal, 1(2999), 691–695.CrossRefGoogle Scholar
  25. Shackelford, S. A., del Junco, D. J., Powell-Dunford, N., Mazuchowski, E. L., Howard, J. T., Kotwal, R. S., et al. (2017). Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA, 318(16), 1581–1591. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Colin H. Murphy
    • 1
  • John B. Holcomb
    • 2
  • John R. Hess
    • 3
    Email author
  1. 1.Department of PathologyUniversity of Maryland Medical CenterBaltimoreUSA
  2. 2.Department of Surgery, University of Alabama at BirminghamBirminghamUSA
  3. 3.Department of Laboratory Medicine, University of Washington School of MedicineSeattleUSA

Personalised recommendations