{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:01:44Z","timestamp":1790420504815,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low\u2010titer O whole blood (LTOWB) has been increasingly incorporated into trauma resuscitation and massive transfusion protocols (MTPs). Recent randomized trials have not demonstrated superiority of prehospital LTOWB over component\u2010based resuscitation, while the utilization and sustainability of LTOWB programs, particularly in low\u2010volume trauma systems, remain incompletely characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>This was a 6\u2010year review (April 2019\u2013April 2025) of trauma MTPs at a level 1 trauma center with a low MTP frequency. Transfusion service logs, trauma flowsheets, prehospital and electronic medical records were reviewed for product usage, LTOWB utilization and discard patterns, and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred and twenty\u2010five MTPs were identified (122 component\u2010only and 11 LTOWB\u2010supported), with predominantly male (70%) and 81% blunt trauma. Component MTPs had a median RBC utilization of 6\u2009units; 45% required \u22641 MTP line. Prehospital LTOWB use was limited: 33% of units were transfused, and only 2 of 13 patients requiring an MTP received prehospital LTOWB. LTOWB\u2010supported MTPs typically issued 10\u2009units, and most patients received 1\u20132\u2009units. Of 524 LTOWB units procured during the first 6\u2009months, 201 were transfused and 323 discarded (62%), with a peak discard rate of 81% early in rollout. Overall, 30\u2010day mortality was 54%, and 25% occurred within 4\u2009h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LTOWB use was limited, and early wastage was substantial. LTOWB implementation in low\u2010volume centers should align inventory and protocols with clinical demand; stewardship measures may reduce waste and improve sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70409","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:20:44Z","timestamp":1790418044000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Massive transfusion practices and low\u2010titer group O whole blood utilization before and after implementation in a low\u2010volume level I trauma center: A six\u2010year review"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9906-9694","authenticated-orcid":false,"given":"Chinelo P.","family":"Onyenekwu","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Transfusion Medicine Division University of Wisconsin\u2013Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra M.","family":"Lehman","sequence":"additional","affiliation":[{"name":"Transfusion Services Laboratory University of Wisconsin Hospital and Clinics  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Trower","sequence":"additional","affiliation":[{"name":"Transfusion Services Laboratory University of Wisconsin Hospital and Clinics  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Woywod","sequence":"additional","affiliation":[{"name":"Department of Nursing \u2010 Practice Innovation University of Wisconsin Hospital and Clinics  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph P.","family":"Connor","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Transfusion Medicine Division University of Wisconsin\u2013Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"e_1_2_9_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"},{"issue":"1","key":"e_1_2_9_3_1","first-page":"S333","article-title":"Joint trauma system, defense committee on trauma, and armed services blood program consensus statement on whole blood","volume":"61","author":"Shackelford SA","year":"2021","journal-title":"Transfusion"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"e390","DOI":"10.1097\/CCM.0000000000006244","article-title":"The efficacy of low\u2010titer group O whole blood compared with component therapy in civilian trauma patients: a meta\u2010analysis","volume":"52","author":"Morgan KM","year":"2024","journal-title":"Crit Care 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and meta\u2010analysis","volume":"161","author":"Ibrahim W","year":"2026","journal-title":"JAMA Surg"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.1056\/NEJMoa2516043","article-title":"Prehospital whole blood in traumatic hemorrhage \u2013 a randomized controlled trial","volume":"394","author":"Smith JE","year":"2026","journal-title":"N Engl J Med"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.1056\/NEJMoa2602167","article-title":"Prehospital resuscitation with type O whole blood for trauma and hemorrhage","volume":"394","author":"Sperry JL","year":"2026","journal-title":"N Engl J Med"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1111\/trf.16394","article-title":"Survey of group a plasma and low\u2010titer group O whole blood use in trauma resuscitation at adult civilian level 1 trauma centers in the US","volume":"61","author":"Yazer MH","year":"2021","journal-title":"Transfusion"},{"issue":"2","key":"e_1_2_9_11_1","first-page":"S85","article-title":"A survey of low titer O whole blood use within the trauma quality improvement program registry","volume":"64","author":"Schauer SG","year":"2024","journal-title":"Transfusion"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1001\/jamasurg.2022.6978","article-title":"Association of whole blood with survival among patients presenting with severe hemorrhage in US and Canadian adult civilian trauma centers","volume":"158","author":"Torres CM","year":"2023","journal-title":"JAMA Surg"},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/SHK.0000000000001685","article-title":"Back to the future: whole blood resuscitation of the severely injured trauma patient","volume":"56","author":"McCoy 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R","year":"2026","journal-title":"QJM"},{"key":"e_1_2_9_32_1","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1111\/trf.15164","article-title":"Optimizing whole blood storage: hemostatic function of 35\u2010day stored product in CPD, CP2D, and CPDA\u20101 anticoagulants","volume":"59","author":"Meledeo MA","year":"2019","journal-title":"Transfusion"},{"key":"e_1_2_9_33_1","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/TA.0000000000002799","article-title":"Hemostatic potential of cold\u2010stored non\u2010leukoreduced whole blood over time: an assessment of platelet function and thrombin generation for optimal shelf life","volume":"89","author":"Assen S","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"e_1_2_9_34_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/vox.70168","article-title":"Implementation of a whole blood programme within a blood service: practical guidance for blood providers","volume":"121","author":"Apelseth TO","year":"2026","journal-title":"Vox Sang"},{"key":"e_1_2_9_35_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1001\/jamainternmed.2017.6369","article-title":"Promoting high\u2010value practice by reducing unnecessary transfusions with a patient blood management program","volume":"178","author":"Sadana D","year":"2018","journal-title":"JAMA Intern Med"},{"key":"e_1_2_9_36_1","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1111\/trf.17874","article-title":"Opportunities to improve feedback to reduce blood component wastage: results of a national scheme evaluation","volume":"64","author":"Staples S","year":"2024","journal-title":"Transfusion"},{"key":"e_1_2_9_37_1","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1111\/trf.17018","article-title":"How we built a hospital\u2010based community whole blood program","volume":"62","author":"Addams 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