Low Titer O Whole Blood Kit - LTOWB

Key Specifications

Kit Contents — Combined

Collection Side (83-0031): All components for donor screening, phlebotomy, blood collection bag, labeling, and documentation.

Administration Side (83-0030):

• IV Catheter, 16ga × 1.25 in. — (2)
• Interlink Injection Site Adapter — (2)
• Needleless Port Connector — (2)
• 450 mL Blood Bag — (1)
• Y-Type IV Set with Filter — (1)
• Beaded Cord, 11 in. — (1) + 550 Cord, 10 in. — (1)
• Constricting IV Band — (1)
• Chloraprep Swabsticks, 3-pack — (2)
• Clear Adhesive Dressing, 4 in. × 5 in. — (2)
• Gauze Pad, 4 in. × 4 in. (2 per pack) — (2 packs)
• Bear Claw Nitrile Gloves, Large — (1 pair)
• Kelly Curved Hemostat (Disposable), 5.5 in. — (1)
• TCCC Card — (1)
• Blood Bag Sticker — (1)
• ASBP 572-EWB Emergency Whole Blood Card — (1)

Product Overview

Blood transfusion at or near the point of injury has been the most impactful advance in combat casualty care of the past two decades. Studies from Iraq and Afghanistan consistently show that early whole blood administration — delivered within minutes to hours of injury — dramatically improves outcomes in casualties with hemorrhagic shock. The challenge has been logistics: maintaining a cold-chain blood supply in austere, far-forward positions is often impossible. The walking blood bank concept solves this by using the unit's own pre-screened personnel as the blood supply.

The NAR LTOWB Kit is the operational realization of this concept. By combining collection and administration into one purchase, NAR eliminates procurement complexity for medical officers building unit-level walking blood bank capability. The kit is pre-assembled, individually sterile, and includes the documentation materials required to complete the LTOWB transfusion chain from donor draw to recipient administration with full ASBP chain-of-custody compliance.

The Valkyrie (USMC MARSOC) and ROLO (75th Ranger Regiment) programs validated this capability at the operational force level. Multiple publications in the Journal of Special Operations Medicine (JSOM) and Prehospital Emergency Care (PEC) have described successful LTOWB transfusions in the field using walking blood bank protocols, with outcomes superior to crystalloid-only resuscitation. The CoTCCC's recognition of whole blood as the preferred resuscitative fluid directly reflects this body of evidence.

Operational Planning for LTOWB Walking Blood Bank

• Pre-deployment: Screen all personnel for blood type; identify and register type O low-titer donors through laboratory testing
• Deployment readiness: Maintain one LTOWB Kit per anticipated casualty position; brief all donors on activation procedure
• Activation trigger: Class III–IV hemorrhagic shock casualty requiring resuscitation beyond available crystalloids or component therapy
• Collection phase: Identify nearest pre-screened LTOWB donor; draw using Collection Set-V
• Administration phase: Establish 16g IV access in recipient; administer via Y-type set using Administration Set-V
• Documentation: Complete TCCC card, Blood Bag Sticker, and ASBP 572-EWB card; attach to casualty for CASEVAC

See also: LTOWB Administration Set-V (83-0030)

See also: LTOWB Collection Set-V (83-0031)

See also: IV/IO & Blood Transfusion Collection

All products sourced from the actual brand manufacturer or authorized master distributors. CoTCCC recommendation status verified where applicable. Ships from MED-TAC International, Pembroke Pines, FL — clinician-founded, veteran-led, SDVOSB-certified.

When to Deploy the Low Titer O Whole Blood Kit

• Far-forward damage-control resuscitation (DCR): Administer pre-screened Type-O low-titre whole blood in the C-phase of TCCC when a casualty presents with haemorrhagic shock and no compatible typed blood is available.
• Pre-operational donor screening programmes: Military and SOF units use the LTOWB kit as part of walking blood bank protocols — pre-screening Type-O volunteers in garrison for low-titre anti-A/B antibodies to reduce transfusion reaction risk.
• MEDEVAC and en-route care: The kit's flat packed size (9.5 × 14 in.) and 0.64 lb weight makes it packable in medic bags and MEDEVAC aircraft for in-flight administration during transport.
• Remote and austere operations: In environments without cold-chain blood storage, fresh whole blood from a pre-screened Type-O donor provides all blood components (RBCs, plasma, platelets) in a single transfusion — impossible with stored component therapy alone.
• Special operations medical capability: SOF Medic protocols include LTOWB as a tactical blood product tool — simplifying the steps, materials, and time required versus full cross-matched fresh whole blood procedures.
• Civilian mass-casualty and disaster response: With appropriate medical director authorisation, LTOWB protocols have been adopted by select EMS agencies for mass-casualty incidents where blood product availability is critical.

How the LTOWB Kit Compares

LTOWB Kit vs. standard Fresh Whole Blood (FWB) collection: Standard FWB requires cross-match testing and ABO/Rh typing at the point of care. LTOWB pre-screens donors for Type-O low-titre status, removing the cross-match step and significantly reducing the time and materials required in austere settings.

LTOWB Kit vs. component therapy (pRBCs + FFP + platelets): Component therapy requires cold-chain storage for each product separately and sophisticated logistics. Fresh LTOWB provides all three components in a single bag — the gold standard for damage-control resuscitation when components are unavailable.

LTOWB Kit vs. LTOWB Collection Set-V (NAR): The Collection Set-V is a related product for blood collection only. The LTOWB Kit (83-0029) is the complete administration kit including IV set, catheter, adhesive dressings, and administration cards. See IV and blood-product tools at tactical-medicine.com for the full ecosystem.

LTOWB Kit vs. crystalloid resuscitation: Crystalloids (NS, LR) restore volume but dilute coagulation factors and red cell mass. LTOWB restores all haemostatic components simultaneously — critical in trauma patients with coagulopathy.

NSN procurement: LTOWB Kit (NSN: 6515-01-707-3174, SKU: 83-0029). LTOWB Transfusion Set NSN: 6515-01-684-9074. Available through DLA and NAR's ECAT contract.

Low Titer O Whole Blood Kit — FAQ

Q: Is the NAR LTOWB Kit CoTCCC-recommended?

A: Whole blood transfusion using pre-screened LTOWB donors is consistent with TCCC's damage-control resuscitation guidelines for haemorrhagic shock. CoTCCC issues guidance on resuscitation principles; always verify current TCCC guidelines for blood product recommendations applicable to your unit's protocols.

Q: Who is authorised to use the LTOWB Kit?

A: The LTOWB Kit is intended for use by trained medical personnel — SOF Medics (18D), Physicians Assistants, 68W Combat Medics, and equivalent civilian roles — under appropriate medical director authorisation and ASBP protocols. Lay responders should not perform whole blood transfusions.

Q: What is the shelf life of the CDP blood bag included in the kit?

A: The CDP (citrate-phosphate-dextrose) anticoagulant blood bag is rated for single-use collection. Shelf life depends on storage conditions; once blood is collected, ASBP protocols specify maximum administration windows. The kit's SF-518 and ASBP 572-EWB V29 documentation cards guide compliant processing.

Q: What are the NSN and procurement details for the LTOWB Kit?

A: SKU: 83-0029. NSN: 6515-01-707-3174. Available through North American Rescue's GSA/ECAT contract. The LTOWB Transfusion Set (for administration) carries NSN: 6515-01-684-9074, and the LTOWB Collection Set NSN: 6515-01-686-2423. Contact MED-TAC International for unit pricing.

Q: Can the LTOWB Kit be used alongside the LifeFlow PLUS for rapid administration?

A: Yes. The LTOWB Kit's Y-type IV set with 170–260 µm filter is compatible with rapid infusion devices. The LifeFlow PLUS (SKU: 30-0287, NSN: 6515-01-703-0004) can administer 1 unit of whole blood in under 2 minutes when paired with appropriate IV access — a recommended combination for DCR in haemorrhagic shock.