How do fresh whole blood and blood component therapies containing additive solutions alter the structure and stability of a blood clot during traumatic bleeding?

Project Description

In a military setting, bleeding is the primary cause of preventable death in patients suffering from polytrauma and massive haemorrhage. Access to hospital care and blood products is limited by location, logistics and personnel. Pre-hospital blood in a military setting offers the potential to improve survival until arrival at hospital. Blood component therapy; individual transfusions of red blood cells, platelets or plasma; has become the key transfusion approach due to their extended shelf life, however, whole blood contains the components in a smaller transfusion volume with higher haematocrit and fibrinogen levels. Blood components are supplemented with additives to stabilise components, reduce pathogens and prolong storage time, which have been shown to alter coagulation factor levels. Additive solution contains saline, adenine, glucose and mannitol, and makes up 45% of the total volume of red blood cells, with an additional volume also allocated to anticoagulant. Studies have shown that sugars including glucose and mannitol can alter fibrin clot structure. Importantly, whole blood doesn’t contain any additive solutions. This project will be of interest to both military and civilian transfusion as it will provide novel data at a cellular and molecular level on how the composition and storage of blood components effect clot structure. It may also provide an insight into which products may be most beneficial for use pre-hospital to control major bleeding after traumatic injury.