Whole blood is the original blood preparation but disappeared from the blood bank inventories in the 1980s following the advent of component therapy. In the early 2000s, both military and civilian practice called for changes in the transfusion support for massive haemorrhage. The 'clear fluid' policy was abandoned and replaced by early balanced transfusion of platelets, plasma and red cells. Whole blood is an attractive alternative to multi-component therapy, which offers reduced hemodilution, lower donor exposure and simplified logistics. However, the potential for wider re-introduction of whole blood requires re-evaluation of haemolysins, storage conditions and shelf-life, the need for leucocyte depletion/ pathogen reduction and inventory management for blood providers. This review addresses these questions and calls for research to define the optimal whole blood product and the indications for its use.

Blood Bank Haugesund hospital Haugesund Norway

Blood Bank Hospital Sirio Libanes São Paulo Brazil

Component Development NHS Blood and Transplant Cambridge UK

Defence Medical and Environmental Research Institute DSO National Laboratories Singapore City Singapore

Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway

Department of Pathology University of Pittsburgh Pittsburgh PA USA

Epidemiology and Preventive Medicine Monash University Melbourne Vic Australia

Hematology Biochemistry and Blood Transfusion Central Military Hospital Prague Prague Czech Republic

Laboratory Medicine University of Washington Seattle WA USA

Medical NHS Blood and Transplant Birmingham UK

Quality Research and Development Military Blood Bank Leiden Netherlands

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