Transfusion for trauma: the French army policy

We read with great interest Moor et al.’s article [1] and were pleased to read of the same concerns that have recently lead to the new battlefield transfusion policy for the Service de Santé des Armées (SSA, French Health Service of the Armies). Given that in case of massive transfusion the ratio of blood products transfused strongly effects mortality [2] the SSA guidelines for massive bleeding are to transfuse red blood cells and clotting factors in a ratio close to the composition of whole blood. Packed red blood cells and plasma must be administered in a 1:1 ratio with transfusion of 0.2 g of fibrinogen for every packed red blood cell unit. The use of fresh whole blood, collected in theatre in selected and volunteer French soldiers, is encouraged. The packed red blood cells available in military blood banks during overseas operations are deleukocyted collected and issued in France according to European regulations. The SSA has chosen to issue a Freeze–Dried Plasma that can be stored at ambient temperature for 2 years and can be reconstituted in < 10 min. Freeze-Dried Plasma is issued from lyophilisation of pooled apheresis plasma, deleukocyted and secured by quarantine. Blood type selection allows dilution and neutralisation of natural anti-A and anti-B haemagglutinin. This Freeze–Dried Plasma is thus compatible with every blood type. The SSA has not chosen to collect and issue platelets and needs in war casualties to rely on fresh whole blood. Blood transfusion in wartime is a challenge both logistically and medically. The daily news from Iraq and Afghanistan reminds us of its importance: nearly a quarter of casualties treated in US Army medical facilities require a blood transfusion [3, 4] and with massive transfusion needed in over 5% [4, 5].