Review by :
This survey reflects the current situation in England and North Wales, where the prevailing opinion is that only the use of blood components is state of the art. There is decreasing need of source plasma for the industrial production of plasma derivatives due to recombinant products. England cannot use the plasma due to fear of vCJD. How to explain the donors that we discard their plasma? On the other hand, there is no contraindication against administering plasma to recipients who get the red cells of the same donor. Plasmatic coagulation in stored whole blood can be preserved rather well, particularly when leukodepleted before storage. Storage can even be prolonged by increasing the concentration of glucose and adenine. The reduction of factor VIII is no problem for most patients because it is even increased under stress. On the other hand, daily experience shows that replacement of only red cell concentrates in additive solution produces hemostatic disorders in massive blood transfusion. The cited publications on the little necessity of plasma in massive transfusion are based on the use of whole blood. Therefore, it is logical to use leukodepleted whole blood in posthemorrhage anemia and perisurgically. The lower hematocrit doesn’t really play an important role today, since we can lower the patients’ hematocrit to less than 0.2 L/L. Why should the patients get red cell concentrates and crystalloids or colloids instead of leukodepleted whole blood?
– V. Kretschmer.