Inclusion Criteria:

• 1. All adults age ≥ 18 years
• 2. Blunt and/or penetrating trauma resulting in long bone or pelvic fractures requiring open reduction internal fixation or closed reduction percutaneous pinning
• 3. Blunt and/or penetrating trauma patient with a. Injury Severity Score (ISS) greater than or equal to 25 b. ISS \> 15 and one of the following: i. \> 4 units of packed red blood cell or \>3 units of whole blood or \>1500 ml of autogenous blood product in the first 24 hours of admission ii. AIS (acute injury score) \> 2 spine iii. Shock on arrival (SBP \< 90)
• OR
• c. ISS \> 15 and two of the following: i. Age \> 55 ii. AIS \> 2 chest iii. +ethyl alcohol on arrival iv. Any red blood cell transfusion in first 24 hours

Exclusion Criteria:

• 1. Patients not expected to survive greater than 48 hours.
• 2. Prisoners.
• 3. Pregnancy.
• 4. Patients receiving chronic corticosteroids or immunosuppression therapies.
• 5. Previous bone marrow transplantation.
• 6. Patients with End Stage Renal Disease.
• 7. Patients with any pre-existing hematological disease.
• 8. Patients deemed to be futile care or have advanced directives limiting resuscitative efforts.
• 9. Patients with severe congestive heart failure (NY Heart Association Class IV).
• 10. Known HIV infection with CD4+ (clusters of differentiation) count \<200 cells/mm3
• 11. Chronic liver disease with MELD (Model for End-Stage Liver Disease) score ≥15
• Elective Hip population

Inclusion Criteria:

• 1. All adults (age ≥18)
• 2. Patient undergoing elective hip repair for non-infectious reasons.
• 3. Ability to obtain Informed Consent prior to operation.

Exclusion Criteria:

• 1. Pregnancy.
• 2. Prisoners.
• 3. Patients receiving chronic corticosteroids or immunosuppression therapies.
• 4. Pre-existing conditions such as pathological fractures, cancer, history of HIV, or history of connective tissue disease.
• 5. Previous bone marrow transplantation.
• 6. Patients with End Stage Renal Disease.
• 7. Patients with any pre-existing hematological disease.
• 8. Patients with known active/symptomatic COVID-19 (Coronavirus disease).