A new international study published in The Lancet eClinicalMedicine has mapped global blood transfusion practices for life-threatening abdominal injuries, highlighting significant variation in care worldwide and opportunities for health systems to learn from one another.
The research, led by the University of Cambridge as part of the GOAL-Trauma study, analysed data from 1,768 patients treated in 187 hospitals across 51 countries. It represents the first multicentre international study to report on blood transfusion strategies for patients undergoing emergency abdominal surgery following trauma (trauma laparotomy).
Uncontrolled bleeding is the leading cause of death following abdominal trauma, making optimal blood transfusion a critical component of care. However, the study found marked variation in how blood is administered across resource settings.
Hospitals in higher-resource settings were significantly more likely to use component therapy – the process of separating donated blood into packed red blood cells, plasma and platelets. In contrast, whole blood transfusion – where blood is used without being separated – was more than twice as common in lower-resource settings.
Shared learning across health systems
While whole blood has remained a routine practice for decades in many lower-resource hospitals, it has recently attracted renewed interest in high-income trauma systems.
The researchers suggest that clinicians in lower-resource settings have accumulated substantial practical experience in organising blood donation and delivering whole blood transfusions in emergency contexts – experience that could help inform its safe and effective use elsewhere.
"For us, whole blood has long been a routine part of trauma resuscitation because it is simpler to store and deliver quickly," said Dr Joachim Amoako, University of Ghana. "It is encouraging to see international data recognising its continued role in trauma care. This supports ongoing efforts to strengthen trauma systems in settings like ours."
Limited uptake of a low-cost life-saving drug
The study also identified low global uptake of tranexamic acid (TXA), an inexpensive medicine known to reduce death from traumatic bleeding when given early.
Despite being recommended as an essential medicine by the World Health Organization, TXA was used in less than 30% of cases globally, highlighting ongoing challenges in translating clinical evidence into routine practice.
"One concerning finding was the low use of tranexamic acid," said Professor Timothy Hardcastle, University of KwaZulu-Natal, South Africa. "TXA is an inexpensive and widely available drug with strong evidence showing it reduces deaths from traumatic bleeding when given early. It is routinely used in obstetric haemorrhage and is often available even in lower-resource settings. Yet it was administered in fewer than one in three patients overall. Improving early use of proven, affordable treatments like TXA could make a meaningful difference to trauma outcomes worldwide."
The researchers conclude that understanding these global variations is an important step towards developing context-appropriate transfusion guidance and designing future international studies. Further investigation into the role of whole blood, they suggest, will be essential to ensure trauma patients receive effective early care, regardless of setting.
