Israeli hospitals adopt IDF’s whole blood policy to save trauma and surgery patients

For many years, it was customary to infuse wounded soldiers and civilian patients in hospitals suffering from serious blood loss or severe anemia with fluids. 

This was then changed to plasma – a light yellow liquid, the main component of whole blood that carries the blood components throughout the body and is comprised of salts, enzymes, hormones, proteins, and water. 

The policy was changed yet again, this time to giving parts of blood including red blood cells that are made by bone marrow and contain a protein called hemoglobin, which carries oxygen from the lungs to all parts of the body. 

In recent years, the IDF decided to supply medics with powdered blood mixed with fluids, which can be restored to treat the wounded on the battlefield. 

The breakout of the Israel-Hamas War meant that immediately supplying whole blood matched by type was even better for saving the wounded – to the satisfaction of the Israel Medical Corps. Whole blood transfusions are now one of the key tools of the Medical Corps during the war.

The most common use of whole blood in the US and other countries is currently autologous donations for elective surgery – a method in which the patient “donates” blood to himself by having it taken from him from five days to six weeks before surgery. 

Although blood donated by the general public and used for most people is thought to be very safe, some people prefer using this method.

The whole blood is refrigerated and then used later. If not used during or after surgery, it is thrown away. In rare cases, a mistake by the blood center or the hospital can result in giving the wrong type of blood, causing serious repercussions.

Recently, some Israeli hospitals have decided to adopt the IDF’s new policy for civilian patients – supplying whole blood immediately in rare circumstances. 

Rare circumstances involve a significant amount of hemorrhaging, such as seen with major trauma requiring massive transfusion, as well as speedy treatment for anemia; coagulopathy (a condition in which the blood’s ability to coagulate is impaired); hypothermia (in which the body’s core temperature drops under 35° Celsius); and acidosis (a rise in acid that overwhelms the body’s acid-base control systems, causing the parts of the brain that regulate breathing to produce faster and deeper breathing).

Dr. Yochay Raviv, a senior anesthesiologist who moved from the Rambam Health Care Campus in Haifa six months ago to Netanya’s Laniado Hospital, decided to implement this method in operating rooms or in the shock room for specific cases. 

Raviv is now the first doctor at Laniado to give a patient whole blood, followed by a second case handled by another doctor for a patient who had suffered a work accident, in which he sustained a deep cut by a disc that severed the carotid arteries.

The whole blood transfusions given to him in the emergency room stabilized his condition immediately and allowed for continued treatment in the operating room.

This procedure is approved by the Health Ministry, while Magen David Adom’s Blood Bank at Tel Hashomer had no problem supplying whole blood, as it does for the IDF.

In another case, a man in his 70s arrived at Laniado Hospital suffering from a complex fracture in his leg. The patient needed urgent emergency surgery, but since he suffered from a shortage of platelets and red blood cells, was not permitted to undergo an operation. 

Instead, he was given a whole blood transfusion within minutes. To prevent any errors of suitability, he was infused with Type O blood only, as it does not cause a dangerous reaction in people with different blood types. 

Due to quick action and cooperation among the orthopedic department, the anesthesia department, and the Blood Bank, the patient received several doses of whole blood. His blood values improved, and he was quickly admitted to the operating room.

“We check for allergies, but we haven’t come across any cases. Neither has the IDF when it provides whole blood,” Raviv told The Jerusalem Post. In all cases mentioned, a specific problem was solved without complications, and the patients have all been discharged. 

Raviv is certain that Laniado Hospital will adopt the policy for other cases. “We have learned a lot and [have] done follow-ups. We’re admitting more cases now of road accidents, trauma, and violence, and whole blood is often useful.”

Prof. Zvi Shimoni, Laniado’s medical director, congratulated the department teams: “Creative thinking is a critical component in saving lives. I congratulate all the teams that were involved in giving whole blood, as a tool that saves an amputated limb. This is an example of thinking outside the box in our operating rooms and departments for the health of the patients.”