A systematic review of indications when and how a military walking blood bank could bridge blood product unavailability

Abstract

Background - Blood supply problems in remote areas such as battlefields are well known. To overcome this shortage, many countries have developed military walking blood bank (WBB) protocols. However, no common standards have yet been set for their use and common actions. Since this procedure involves a certain degree of risk, it would be interesting to analyse the activation criteria that lead to the use of this exceptional protocol. Therefore, the aim of this literature review was to highlight the indications of use for a WBB and the common risk mitigation measures.

Material and methods  - This PRISMA-compliant review only included studies that describe adult male military casualties requiring blood transfused locally using a walking blood transfusion protocol. All relevant data (i.e., activation and contextual factors and risk mitigation measures) were tabulated to retrieve information from the selected military studies.

Results - Our results indicated that activation criteria were homogeneous across the 12 reviewed studies. Whole blood was collected from a WBB when there was a shortage of blood products and when platelets were needed.  In the literature reviewed, the main risks associated with such a protocol, namely hemolytic adverse events and transfusion transmitted diseases, are mitigated by the use of typing and screening measures if they are reported.  However, there is less consistency in the implementation of those risk mitigation measures.

Discussion - This exceptional protocol is activated for two main reasons; either logistical or clinical. In contrast to the activation criteria, there is no consensus on risk mitigation measures across studies. The remaining differences between protocols mainly reflect different legal obligations and national organisations. These findings highlight the importance of early medical planning as well the key role of the donor. Their pre-deployment education and regular follow-up are essential for the safety of the future patient.