Endless Improvement of Transfusion Medicine in Military Medical Organizations

Hassan Jalaeikhoo ¹; Amir Seyed Ali Mehbod ²; Mohsen Rajaeinejad ¹

¹ Cancer Research Center, AJA University of Medical Sciences, Tehran, IR Iran

² Department of Hematology, Faculty of Paramedicine, AJA University of Medical Sciences, Tehran, IR Iran

Trauma to the army personnel is common at battle-fields. Uncontrolled major hemorrhage occurs from both blunt and penetrating trauma, which may lead to hypovolemic shock and death. Controlling the source of bleeding is a priority. In these victims damage control resuscitation is a systematic approach to major trauma. The aim of damage control resuscitation is to aggressively minimize hypovolemic shock and limit the development of coagulopathy, hypothermia and acidosis known as lethal triad.

This new therapeutic paradigm differs considerably in many important respects from previous management strategies for catastrophic blood loss. The main elements of damage control resuscitation are immediate correction of specific coagulopathies, induced by hemorrhage and management of several extreme homeostatic imbalances that may appear after resuscitation. Clotting factor declines in the bleeding patient but this decline is often out of proportion compared to the reduction that is due to dilution alone. Trauma-associated coagulopathy is attributed to one of four basic mechanisms including: qualitative platelet defect, diffuse endothelial cell injury, depletion of coagulation factors and platelet or secondary to disseminated intravascular coagulation (DIC).

Following initial stabilization, the aim is to prevent or reverse complications that worsen outcomes such as hypothermia, electrolyte disturbances, metabolic acidosis and coagulopathy. This can be achieved through close monitoring of the patient.

Keywords: War; Blood Management; Trauma

Ali Noroozi Aghideh ¹; Amir Seyed Ali Mehbod ¹; Mahdi Ghorbani ¹

¹ Department of Hematology, Faculty of Paramedicine, AJA University of Medical Sciences, Tehran, IR Iran

Background: In a battle or war zone, blood is a precious commodity that must be supplied quickly and safely. Blood transfusions have been shown to be lifesaving in combat casualties since World War I. Development of the first blood substitutes, dates back to the early 1600s, and the search for the ideal blood substitute continues. A number of driving forces have led to the development of artificial blood substitutes. One major force is the military, which requires a large volume of blood products that can be easily stored and readily shipped to the site of casualties. Frozen blood products have been used on deployed military operations since the Vietnam War. Since World War II, the search for a suitable alternative for blood has been intensified, to enable coping with war-like situations and large-scale civilian disasters. The purpose of this study was to review the potential clinical uses of erythrocyte substitutes and frozen blood products in treating military battlefield casualties, with specific emphasis on combat injury rates and wounding patterns, resuscitation doctrine and logistic requirements.

Methods: Review of published military medical literature and unclassified documents from the armed forces blood program.

Results: Hemorrhage is the leading cause of death on the battlefield. Early intervention, with definitive treatment, could save up to 30% of soldiers who are killed in action or who die of wounds. The role for oxygen-carrying fluids in the initial management of military injuries is undefined; however, erythrocyte substitutes have many benefits compared to donated blood and could reduce the logistic requirements for blood in field hospitals.

Conclusions: Safety, long storage life, light unit weight, availability, low cost, universal compatibility, and tolerance to environmental extremes are all characteristics that are necessary for blood substitutes to extend or replace the use of stored blood in treating battlefield casualties.

Keywords: War, transfusion, artificial blood, frozen blood

Esmaeil Samizadeh ¹; Ali Noroozi Aghideh ²; Mahdi Ghorbani ²

¹ Department of Pathology, Army Hospital Imam Reza (501), Tehran, IR Iran

² Department of Hematology, Faculty of Paramedicine, AJA University of Medical Sciences, Tehran, IR Iran

Providing blood for the recipient is not an easy task at all. During war much more effort is required.

The most important medical advancement of World War I was blood transfusion. About a century later, along the multiple wars around the world, the development continued and resulted in a thoughtful flexible emergency plan, standardized blood bank program, blood loss management, blood storage and its products, bloodless surgery and donor recruitment strategies. Local blood supply is considered a critical factor in conquering such emergencies during war.

Usage of war garment goes back to fifth century B.C by the Chinese. Invention of Kevlar fiber by Stephanie kwolek in 1964 revolutionized the bullet-proof vest industry. Nanotechnology was utilized in 2005. During year 2008, usage of synthetic silk, which is twenty folds stronger than steel, has been the latest innovation. Dog tags are invaluable sources of information in the battlefield. They are two copies of personal information, blood type, inoculation history and even special medical conditions. This idea was used for the first time in 19th century.

Adolf Lorenz started bloodless surgery at the beginning of the 20th century. Volume expander, autologous transfusion and blood substitute are utilized. Special surgical instruments such as gamma knife, electrocautery, Aragon beam and hypotensive anesthesia are needed. Intra-operative blood salvage and acute normovolemic hemodilution are also useful. The defense minister of the US focused on empowering the army doctor by training bloodless surgery.

Pre-transfusion screening include routine ABO and Rh type, Ab screening and Ab identification in some circumstances. Management of blood transfusion during war is an interdisciplinary task. Army national blood organization media are the cornerstone of an appropriate blood bank program.

Keywords: War; Blood Transfusion; History