{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:07:02Z","timestamp":1779170822556,"version":"3.51.4"},"reference-count":20,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100013132","name":"Combat Casualty Care Research Program","doi-asserted-by":"publisher","award":["B_026_2020"],"award-info":[{"award-number":["B_026_2020"]}],"id":[{"id":"10.13039\/100013132","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hemorrhagic shock remains a leading cause of preventable death. Whole blood (WB) transfusion provides comprehensive resuscitation but is limited by storage\u2010related degradation under standard refrigerated citrate\u2010phosphate\u2010dextrose\u2010adenine (CPDA\u20101) conditions. A novel additive solution (APEX) was designed to mitigate storage lesions and extend WB functionality. This study evaluated the hemostatic preservation and resuscitative efficacy of APEX\u2010stored WB in a rat model of decompensated hemorrhagic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>WB was collected from anesthetized donor rats into CPDA\u20101 or CPDA\u20101\u2009+\u2009APEX (7:5 ratio) and stored refrigerated (1\u20136\u00b0C) for 14\u2009days. Recipient rats underwent a fixed\u2010volume (65% estimated blood volume) hemorrhage followed by resuscitation with stored WB. Physiologic recovery, hemostatic function (rotational thromboelastometry [ROTEM]), and metabolic parameters were assessed over 120\u2009min post\u2010hemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      APEX\u2010stored WB maintained comparable platelet and leukocyte counts and hemostatic indices to CPDA\u20101 WB after 14\u2009days. Rats resuscitated with APEX WB showed improved metabolic recovery over CPDA\u20101, exhibiting significantly lower lactate (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.022) and higher glucose (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.021) levels at 120\u2009min post\u2010hemorrhage. Coagulation parameters (obtained by ROTEM) remained near baseline in APEX\u2010treated animals, whereas CPDA\u20101 WB induced a hypercoagulable, fibrinolytic profile. A modest increase in lung wet\/dry ratio was observed in the APEX group, with no intestinal edema.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In this preclinical model, we observed that APEX additive solution preserved rat WB quality and supported superior physiological recovery compared with standard CPDA\u20101 storage. These pilot findings support further investigation of APEX as an alternative WB storage technology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70117","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:20:28Z","timestamp":1770960028000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transfusion efficacy of novel anticoagulant\u2010preservative solution in a rat model of decompensated hemorrhagic shock"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2626-9780","authenticated-orcid":false,"given":"Kristin M.","family":"Reddoch\u2010Cardenas","sequence":"first","affiliation":[{"name":"U.S. Army Institute of Surgical Research JBSA\u2010FT  Sam Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1024-0900","authenticated-orcid":false,"given":"Xiaowu","family":"Wu","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research JBSA\u2010FT  Sam Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffery D.","family":"Keesee","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research JBSA\u2010FT  Sam Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Liu","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research JBSA\u2010FT  Sam Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica M.","family":"Lopez","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research JBSA\u2010FT  Sam Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott.","family":"Kelly","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research JBSA\u2010FT  Sam Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colby","family":"McIntosh","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research JBSA\u2010FT  Sam Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Meledeo","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research JBSA\u2010FT  Sam Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn","family":"Jensen","sequence":"additional","affiliation":[{"name":"Hemerus Medical LLC  St. Paul Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majid","family":"Zia","sequence":"additional","affiliation":[{"name":"Hemerus Medical LLC  St. Paul Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1093\/milmed\/usy120","article-title":"Whole blood transfusion","volume":"183","author":"Cap AP","year":"2018","journal-title":"Mil Med"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"S190","DOI":"10.1111\/trf.13491","article-title":"Whole blood for hemostatic resuscitation of major bleeding","volume":"56","author":"Spinella PC","year":"2016","journal-title":"Transfusion"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1111\/vox.13005","article-title":"Whole blood haemostatic function throughout a 28\u2010day cold storage period: an in vitro study","volume":"116","author":"McRae HL","year":"2021","journal-title":"Vox 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pre\u2010hospital pharmaceutical intervention for trauma and hemorrhagic shock","volume":"14","author":"Wu X","year":"2024","journal-title":"Sci Rep"},{"key":"e_1_2_10_12_1","volume-title":"Procedure for determining packed cell volume by the microhematocrit method: approved standard","author":"Assendelft OW","year":"1993"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1111\/trf.14084","article-title":"Red blood cells derived from whole blood treated with riboflavin and ultraviolet light maintain adequate survival in vivo after 21\u2009days of storage","volume":"57","author":"Cancelas JA","year":"2017","journal-title":"Transfusion"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1111\/trf.15748","article-title":"Cold\u2010stored leukoreduced CPDA\u20101 whole blood: in vitro quality and hemostatic properties","volume":"60","author":"Sivertsen J","year":"2020","journal-title":"Transfusion"},{"key":"e_1_2_10_15_1","first-page":"27","article-title":"Red blood cell storage lesion: causes and potential clinical consequences","volume":"17","author":"Yoshida T","year":"2019","journal-title":"Blood Transfus"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1111\/voxs.12501","article-title":"Platelet functionality in cold\u2010stored whole blood","volume":"14","author":"Kristoffersen EK","year":"2019","journal-title":"ISBT Sci Ser"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/SHK.0000000000000748","article-title":"Limited resuscitation with fresh or stored whole blood corrects cardiovascular and metabolic function in a rat model of polytrauma and hemorrhage","volume":"47","author":"Chen J","year":"2017","journal-title":"Shock"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3233\/CH-170248","article-title":"Rat red blood cell 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