A Descriptive Analysis of Supermassive Transfusion Recipients Among US and Coalition Forces During Combat Operations in Afghanistan and Iraq.

This article focuses on characterizing supermassive transfusion (SMT) recipients—combat casualties receiving the highest quartile of packed red blood cells (PRBCs) or whole blood (WB) within 24 hours—using data from the U.S. Department of Defense Trauma Registry. Among 2,608 U.S. and Coalition casualties who received blood products, those in the SMT cohort (≥18 units) had more severe injuries, were more often injured by explosives, exhibited greater vital sign and laboratory derangements, and experienced lower survival to hospital discharge compared to other transfusion recipients. Injuries to the extremities, skin, abdomen, and thorax were significantly associated with SMT, while head and neck injuries were not. The study highlights the need for early identification of SMT patients to facilitate rapid resource mobilization but notes limitations including retrospective design, data completeness, and applicability primarily to military settings.