Putting Blood Back Together: Whole Blood vs Components in Trauma: A Meta-Analysis

Introduction: Trauma is the leading cause of death in individuals aged 1–46 and demands rapid resuscitation to control life-threatening bleeding. Military data suggest that whole blood (WB) offers superior survival and faster hemostasis compared to component therapy (CT). With its balanced composition, WB reduces coagulopathy and transfusion requirements while simplifying logistics. This meta-analysis compares WB and CT in trauma care for patient-centered outcomes.


Methods: We systematically searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to March 2025 using combined keywords and MeSH terms ("whole blood," "transfusion," "component therapy," "trauma"). Two reviewers independently screened titles, abstracts, and full texts. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. Data were synthesized using random-effects meta-analysis, with heterogeneity assessed via I² statistics. Publication bias was evaluated using funnel plot asymmetry and Egger’s test. All analyses were performed in RevMan 5.4.


Results: Out of 6,356 identified studies, 16 (n = 8,893 patients) met inclusion criteria. The mean age was 37.03 years (SD ± 22) in the WB group and 37.86 years (SD ± 22.25) in the CT group. Studies varied in design, setting, interventions, and outcomes. Meta-analysis showed no significant difference in 24-hour mortality (RR = 0.91; 95% CI = 0.64–1.30), 28/30-day mortality (RR = 0.92; 95% CI = 0.68–1.24), infection rates (RR = 0.97; 95% CI = 0.83–1.14), or acute kidney injury (RR = 1.06; 95% CI = 0.38–3.01) between WB and CT.


Conclusions: Whole blood (WB) is as effective as component therapy (CT) for trauma resuscitation. Although its shorter shelf life may pose challenges for routine use, WB’s hemostatically balanced profile minimizes dilutional coagulopathy and reduces the need for large-volume transfusions compared to CT. With uniform storage requirements, WB simplifies transport logistics, unlike CT, which demands varied temperature controls for each component. WB also reduces costs by 17% through fewer transfusions, easier handling, and potential survival benefits seen in some studies. Whole blood could be a cost-effective and volume-restricted alternative during non-military trauma resuscitation.