ISSN: 1300-7777 E-ISSN: 1308-5263
Bringing PRBC to the point of combat injury: are we there yet? [Turk J Hematol]
Turk J Hematol. Ahead of Print: TJH-68984 | DOI: 10.4274/tjh.2018.0081  

Bringing PRBC to the point of combat injury: are we there yet?

Aytekin Ünlü1, Soner Yılmaz2, Özlem Yalçın3, Metin Uyanık4, Patrizio Petrone5, Rıza Aytaç Çetinkaya6, İbrahim Eker7, Murat Urkan1, Taner Özgürtaş8, İsmail Yaşar Avcı9, Nazif Zeybek1
1Health Science Univercity, Gulhane Training and Research Hospital, Department of General Surgery; Etlik, Ankara, Turkey
2Health Science Univercity, Gulhane Training and Research Hospital, Regional Blood and Training Center; Etlik, Ankara, Turkey
3Koc University School of Medicine, Hemorheology, Hemodynamics and Vascular Biology Laboratory,; Sariyer, Istanbul, Turkey
4Corlu State Hospital, Department of Biochemistry, Tekirdag, Turkey
5Department of Surgery, NYU Winthrop Hospital; Mineola, L.I., New York. USA. New York Medical College; Valhalla, New York, USA. University of Las Palmas de Gran Canaria; Canary Islands, Spain
6Health Science Univercity, Sultan Abdulhamid Han Training and Education Hospital, Department of Infectious Disease, Istanbul, Turkey
7Afyon Kocatepe University, Faculty of Medicine, Department of Pediatric Hematology. Afyon,Turkey
8Health Science Univercity, Gulhane Training and Research Hospital, Department of Biochemistry; Etlik, Ankara, Turkey
9Health Science Univercity, Gulhane Training and Research Hospital, Department of Infectious Disease and Clinical Microbiology; Etlik, Ankara, Turkey

Introduction: Hemorrhage is the leading cause of injury related pre-hospital mortality. We investigated worst case scenarios and possible requirements of Turkish Military. As we plan to use blood resources during casualty transport, the impact of transport related mechanical stress on PRBC (packed red blood cell) were analyzed.
Material and Methods: The in vitro experiment was performed in the environmental test laboratories of ASELSAN®. Operational vibrations of potential casualty transport mediums such as Sikorsky Helicopters, Kirpi® Armoured Vehicle and NATO vibration standardsoftware MIL-STD-810G were recorded. The most powerful mechanical stress, which was created by the NATO standard, was applied to 15 units of fresh (≤ 7 days) and 10 units of old (>7 day) PRBC in a blood cooler box. The vibrations were simulated by TDS v895 Medium-Force Shaker Device. On site blood samples were analyzed at 0, 6th and 24th hours for biochemical and biomechanical analyses.
Results: The mean age of fresh and old PRBCs was 4.9 (SD ± 2.2) and 32.8 (SD ± 11.8) days, respectively. Six-hour mechanical damage of fresh PRBC was demonstrated by increased erythrocyte fragmentation rates (p=0.015), hemolysis rates (p=0.003), supernatant potassium levels (p=0.003) and decreased hematocrit levels (p=0.015). Old PRBC hemolysis rates (p=0.015), supernatant potassium levels (p=0.015), supernatant Hb (p=0.015) were increased and Htc levels were decreased (p=0.015) within 6 hours. Two (%13) units of fresh and none of the old PRBC were eligible for transfusion after 6 hours of mechanical stress.
Conclusion: When the austere combat environment was simulated for 24 hours, fresh and old PRBC hemolysis rates were above the quality criteria. Currently, a technology to overcome this mechanical damage does not seem to exist. In the light of the above data, a new national project is being performed.

Keywords: Combat trauma; Blood transport; Prehospital transfusion; Hemolysis.




Corresponding Author: Soner Yılmaz, Türkiye


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