ASBP’s low titer Type O whole blood helps save lives on the battlefield

Published June 7, 2017
By Jessica Pellegrini, ASBP Staff Writer

The Armed Services Blood Program is working with the Army’s 75th Ranger Regiment to bring low titer type O whole blood farther forward and closer to the point of injury. According to Army Lt. Col. Ethan Miles, 75th Ranger Regiment surgeon, it’s a blood product that could save more lives on the battlefield.

“Historically, we have done very well treating preventable death at the point of injury. This program aims to treat hemorrhagic shock which is the leading cause of potentially survivable death on the battlefield,” Miles said. “By enabling our medics to have a practical way to administer whole blood at the point of injury, we seek to extend the period of survivability for non-compressible hemorrhage enabling successful transport to definitive surgical care.”

The low titer type O whole blood program is different than a normal type O donation. Donors for this program are group O donors prescreened for IgM antibodies to group A and group B blood. If the levels come back at less than 1:256, the donor is considered “O low titer.” Donors are also prescreened for infectious disease. Once they are cleared, their blood is considered universal and safe to be transfused to anyone regardless of the injured patient’s blood type.

“By pre-identifying these individuals, we greatly increase the speed and safety for performing blood transfusions far forward in the combat environment,” Miles said. “Once cleared, they serve as a walking blood bank on target, thus enabling us to draw blood from within the assault force.”

In addition to the prescreening process, low titer type O whole blood is also not separated into three components as a regular blood donation would be.

“The program is a way to provide a more efficacious blood product far forward on the battlefield,” said Army Lt. Col. Jason Corley, deputy director of the Army Blood Program. “So we don’t have to bring forward three different bags for three different components — red blood cells, plasma and platelets. We can give a patient at the point of injury what they need all in one bag.”

“Given the logistical constraints with providing frozen plasma and platelet components, whole blood can be stored in a standard refrigerator and used at all roles of care. A whole blood unit is often the only source of platelets for forward surgical teams or in pre-hospital settings,” said Army Col. Audra Taylor, director of the Army Blood Program.

The Army Blood Program prescreened the first Ranger Regiment donors in May 2015. Several months later, elements of the Ranger Regiment deployed and were able to use prescreened low titer O donors to support combat operations.

While deployed, Dr. Miles coordinated with the theater blood program to utilize low titer O whole blood collected and manufactured in the United States, and shipped around the world using military airlift. Shipping in this whole blood product helped to greatly expand the available inventory to deployed Rangers.

The program has been growing ever since. In just 18 months, the program went from concept to implementation. The Armed Services Blood Bank Center-Pacific Northwest at Joint Base Lewis-McChord, Washington, sent the first shipment of low titer type O whole blood to Afghanistan in March 2016.

“Since then, we’ve provided over 1,000 units to CENTCOM,” Taylor said. “We are also expanding the program to make it a tri-service endeavor. With more donor centers collecting and producing this product, we are able to make sure that our service members downrange have the products they need when they need it the most.”

The Keesler Air Force Base Blood Donor Center and two additional Army Blood Donor Centers recently started manufacturing and shipping low titer O whole blood. The Navy Blood Program will be making the product within another month.

According to Corley, the Navy and Air Force blood programs are also working with their special operations communities to develop donor prescreening procedures. The goal is to develop processes which are very similar across the services so that all donors will be prescreened to the same standard.

“This is a great product that will certainly help save lives of our service members,” said Navy Capt. Roland Fahie, director of the Armed Services Blood Program. “By expanding this program and making it a true tri-service effort, we are able to increase the amount of low titer type O whole blood we are producing which, of course, equates to more lives saved.”

In addition to manufacturing more of the blood product in the United States, Miles said the program is already spreading throughout the U.S. Special Operations Command and the Department of Defense.

“Next up for the O-low titer blood use is the medevac system,” he said. “Recently, the medevac Vampire system guidelines have been updated to include the use of whole blood. We are also seeing increased use and demand by surgical teams. As more medical providers switch over to whole blood, the availability will increase while waste decreases.”

In March, the 75th Ranger Regiment’s Ranger O Low Titer Whole Blood Program was recognized by the Army Material Command as the winner of the Army’s Greatest Innovation Award.

“It is a true honor to receive an award like this, although nothing compares to knowing we are providing the best care possible to Rangers every day,” Miles said. “Most importantly it brings highlight to saving lives on the battlefield and furthers the support for whole blood forward. Our nation’s wars are still ongoing and we are putting our Soldiers, Sailors, Airmen and Marines in harm’s way every night. We owe them the best care possible and this is one way we can do that.”

“None of this would be getting done if it hadn’t been for the Rangers initially pushing this idea on whole blood use,” Corley said. “Big credit goes to Dr. Andre Cap and his team for being the research and technical push and support behind all of this. They came up with the ideas and the Army Blood Program just helped to operationalize it.”

According to Miles, while the award was a great honor the most important aspect of the program is the ability to save lives of injured service members deployed downrange. Fahie credits the researchers, doctors, medics and command leadership for making it possible.

“This program is also an example of what can happen when a military unit puts emphasis on the importance of combat casualty care,” Miles continued. “The 75th Ranger Regiment has historically placed medical as a top priority and continues to do so today. With this backing and support, we have been given the freedom and ability to pursue excellence in the field and I believe this will pay off for generations to come both inside and outside of the 75th Ranger Regiment.”