LAUSR

BACKGROUND Whole blood (WB) was historically transfused as a type-specific product. Given recent advocacy for low-titer group O whole blood (LTOWB) as a universal blood product, we examined outcomes after LTOWB transfusion stratified by recipient blood groups. STUDY DESIGN Adult trauma patients receiving prehospital or in-hospital transfusion of LTOWB (11/17-07/20) at a single trauma center were prospectively evaluated. Patients were divided into blood groups (O, A, B, AB). Major complications and survival to 30 days were compared. Univariate analyses among blood groups were followed by purposeful regression modeling, reflecting 6 variables of significance: male sex, White race, injury severity, arrival lactate, arrival SBP, and ED blood products. RESULTS Of 1075 patients receiving any LTOWB, 539 (50.1%) were Group O, 340 (31.6%) Group A, 150 (14.0%) Group B, and 46 (4.3%) Group AB. There were no statistically significant differences in demographics, injury severity, hemolysis panels, prehospital vitals, or resuscitation parameters (all p>0.05). However, arrival systolic pressure was lower (91 vs 102, p=0.034) and lactate worse (5.5 vs 4.1, p=0.048) in Group B patients compared to other groups. While survival and most major complications did not differ across recipient groups, acute kidney injury (AKI) initially appeared higher for Group B. Stepwise regression did not show a difference in AKI rates. This analysis was repeated in patients receiving only component products. Group B again showed no significantly increased risk of AKI (13%) compared to other groups (O: 7%, A: 7%, AB: 5%; p=0.091). CONCLUSIONS LTOWB appears to be a safe product for universal use across all blood groups. Group B recipients arrive with worse physiologic values associated with hemorrhagic shock whether receiving LTOWB or standard component products.