Evaluating the safety outcomes of whole blood versus component transfusion in trauma: A meta-analysis of 59,213 patients

Abstract

Background

Blood transfusion can play a critical role in saving lives by replenishing lost blood volume and helping to stabilize patients. This meta-analysis aims to compare the clinical effectiveness of whole blood (WB) transfusion against component therapy (CT) in the treatment of individuals suffering from traumatic injuries.

Methods

A comprehensive search of electronic databases was conducted up to March 2025 to identify randomized controlled trials and cohort studies. Data from continuous and categorical outcomes were synthesized using a random-effects model, producing mean differences (MD) and odds ratios (OR) along with corresponding 95 % confidence intervals (CIs).

Results

A random-effects meta-analysis of 14 studies showed a significant reduction in 24-h all-cause mortality with whole blood transfusion compared to component therapy (OR: 0.67, 95 % CI [0.50, 0.88]; p = 0.005). No significant differences were found between the two groups for length of hospital stay, ICU stay, days on ventilator, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), or sepsis. Specifically, the length of hospital stay (WMD: −1.57, p = 0.06), ICU stay (WMD: −0.20, p = 0.75), days on ventilator (WMD: −0.57, p = 0.24), ARDS (OR: 1.34, p = 0.30), and AKI (OR: 0.91, p = 0.63) showed no statistically significant differences, while sepsis (WMD: 1.10, p = 0.74) also revealed no significant variation between the groups. Removal of certain studies reduced heterogeneity in several outcomes.

Conclusion

Although whole blood has been demonstrated to improve 24-h mortality, the current findings are limited by observational data to classify it as a completely safe approach, thus necessitating the need for more randomized controlled trials (RCTs).