Whole blood as an alternative for component transfusion?

Blood services commonly separate whole blood (WB) into its components of red cells, platelets and plasma. This enables storage of the components under conditions that optimise their quality for as long as possible, and enables transfusion of only the required components to each recipient. However, there are certain situations where separation and storage of components is not possible, and some evidence that components may not be the best therapy for major trauma. Nevertheless, there are significant risks associated with WB transfusion such as transfusion transmitted infections, alloimmunisation to human leucocyte antigens (HLA), post‐transfusion purpura (PTP), and transfusion associated graft versus host disease (TA‐GvHD). The use of leucodepletion (LD) filters is relatively simple and has significant benefits such as reduced incidence of febrile transfusion reactions, reduced HLA immunisation, and reduced risk of TA‐GvHD and PTP. The LD process reliably reduces the transmission risk of cytomegalovirus (CMV) and of Human T‐cell lymphotropic virus (HTLV). There is also interest in the use of WB that has undergone a pathogen inactivation (PI) process, with storage either at refrigerated or ambient temperature. Initial studies suggest acceptable blood quality, killing of parasites, viruses and bacteria, and inactivation of any residual leucocytes. The transfusion of FWB in the developing world is a relatively common practice, as not all hospital or blood bank facilities can support component production, but there are arguments against the use of component therapy such as the delay in obtaining components, the cost (to the patient's family) of the treatment, and the wastage of the plasma. It is clear that the use of component therapy may not be the most appropriate practice for all healthcare systems and the ability to use safely WB, whether fresh or stored, may be of significant benefit. The associated risks may be mitigated to some extent by the use of established and novel techniques, such as LD and PI.