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Low-Titer O Whole Blood Saves Lives on the Battlefield

Image of Low-Titer O Whole Blood Saves Lives on the Battlefield. Pictured is low-titer O whole blood, an important blood product that can be transfused into patients of any blood type, making it a valuable tool for the military, which often needs to transfuse blood in austere environments. Fort Leonard Wood Blood Donor Center is one installation producing this lifesaving blood product for the Armed Services Blood Program (Photo Credit: Carl Norman).

When America’s military members are injured on the battlefield, medics walk a line between life and death trying to get them help. They have many resources in their medical kits, and one of the newer tools they have is low-titer O whole blood.

Low-titer O whole blood, more commonly referred to as LTOWB, was created by an Armed Services Blood Program initiative that collects blood from donors who have had an antibody titer test showing that they have low levels of anti-A and anti-B antibodies; high levels of these antibodies can cause transfusion reactions in patients with other blood types, according to U.S. Army Col. Christopher Evans, director of the Army Blood Program.

“LTOWB can be transfused into patients of any blood type, making it a valuable tool for the military which often needs to transfuse blood in austere environments where blood typing is not always possible,” he said. “It’s been shown to be safe and effective in military settings, especially during combat operations. In a study of soldiers who received it during combat operations in Iraq and Afghanistan, the risk of transfusion reactions was significantly lower than those in soldiers who received blood from traditional blood banks.”

LTOWB contains red blood cells, plasma, and platelets from a single donor, Evans said. It’s often used for transfusions in emergency situations or for patients who require massive transfusions.

“Donors with type O blood are the most common source of LTOWB because they are universal donors, meaning that their blood can be transfused to patients with any blood type without causing an adverse immune response.”

With LTOWB containing both red blood cells and plasma, Evans said it’s been suggested that it may have advantages over transfusion with red blood cells alone in certain situations, such as in patients with massive hemorrhage or traumatic injuries.

The Fort Leonard Wood Blood Donor Center in Missouri is one of seven U.S. Army blood donor centers that collect LTOWB for the ASBP. It is a strategically important asset for the U.S. Army, according to Evans. The facility is a central location, making it an ideal hub for blood collection and distribution for both the Midwest region and worldwide combat operations. Collecting blood from donors throughout the region, the center distributes to military hospitals and clinics across the Midwest.

“The center also plays a vital role in the LTOWB program,” he said. “This is a valuable tool for the military, and Fort Leonard Wood’s donor pool makes them an important part of the Army's blood supply chain to support the military’s blood mission.”

“Using whole blood products is an older concept that was abandoned due to its risk of causing severe transfusion reactions and using individual components (red cells and plasma separately) has been the product of choice since World War II,” said U.S. Army Capt. Marianne Rose, director of the Fort Leonard Wood Blood Donor Center. “However, with a better understanding of blood over time, and through trial and error, whole blood has resurfaced, but with some exceptions, such as low titer, which is now being used to treat massive transfusion traumas, and it’s proving to be better than component therapy in certain circumstances.”

The LTOWB program is only one part of the mission that the Fort Leonard Wood Blood Donor Center supports. The center also provides many other products including packed red blood cells and fresh frozen plasma that help people around the world recover from injury and illness. FLW BDC is also now partnering with the DOD bone marrow donor program, Salute to Life, explained Rose.

“But we can’t do what we do without donors who are willing to give. We’re asking everyone on Fort Leonard Wood to celebrate their health by giving blood so we can continue making low-titer O whole blood and all blood products available to those protecting our freedom at home and abroad.”

The Fort Leonard Wood Blood Donor Center accepts appointments and walk-in donors every Monday through Wednesday from 8 a.m. – 4 p.m. CDT. To make an appointment or for more information about the ASBP mission and donor eligibility, call 573-596-6150.

Armed Services Blood Program

Since 1962, the Armed Services Blood Program is the official blood program of the United States military. Our mission is to provide quality blood products and support to military health care operations worldwide; from the battlefield to the local hospital, whenever and wherever needed. The ASBP collects, processes, stores, transports, and distributes blood products to service members, their families, retirees and veterans in peace and war. In an ASBP Enterprise view – Military Health Affairs, Defense Health Agency, Service Blood Programs and Combatant Commands – we operate under common goals, metrics, procedures, and work together to shape the future.

The ASBP is one of four organizations tasked with providing a safe blood supply to the nation. Our program also works closely with our civilian counterparts in times of need to maximize the availability of this national treasure.


To find out more about the ASBP or schedule an appointment to donate, please visit www.health.mil/asbp.To interact directly with ASBP staff members or get the latest news, follow us @militaryblood on Facebook and Twitter, and @usmilitaryblood on Instagram.

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Last Updated: January 10, 2024
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