Your experience with massive blood transfusion !

[DrAmir0078]

Happy Holidays SDN Anesthesiologists,
Christmas on doorstep and the new year just about to crossing the front street, and then "knock knock 2022".
I would like to ask you about massive blood transfusion - with such puzzle, yet I know a bit to answering the puzzle, but I had created this puzzle to get the full picture.

Here we go :

Case presentation :
Patient with Unknown ABO is undergoing Emergent surgery requires massive blood transfusion.
- if O - ve available, how many units can give (cut off) prior to the arrival of ABO specific type?
(I know up to 2 units, Mr. Morgan said 8 units - page 827)


- if blood specific didn't arrive, and not available? continuing with O - ve and like to say was given 10 units - it is prohibited to give then type specific cross match blood, but when it is safe to give it (after how long?)
(I heard then after 1 month is safe to go back to type specific - but any evidence?)


- if the patient above type specific is A +ve, and has been given 2 units only O - ve, and there is only 3 A +ve units available; it is safe to transfuse (I know), but then requires more 5 units and only O +ve available, at this time is it safe to transfuse O +ve? then when it is safe to (later on) to transfuse A +ve? - what a puzzle?


Thanks a lot for answering!

Love and Peace
Amir

P. S. add as much puzzle as you can to load me with knowledge

Adding up : above units are whole blood, because in Iraq we have limited PRBCs, most of the time is Whole blood!

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[anbuitachi]

not exactly what you are asking but what is the other option? it sounds like the option of not transfusing would mean death, if you are out of O blood and you are still hemorrhaging.

 

[DrAmir0078]

not exactly what you are asking but what is the other option? it sounds like the option of not transfusing would mean death, if you are out of O blood and you are still hemorrhaging.

I am with you - it sounds my question above a bit confusing...

Patient with trauma, admitted to the OR immediately (consider Iraq) - we per knowledge can transfuse up to 2 units of O negative (whole blood - I know it is of no use in the US right?), and if patient blood type and cross match arrived and let us to say A positive, but Blood bank was running out of A positive except O positive, here I can transfuse O positive... I get that Dr. Anbuitachi.
But Mr. Morgan textbook have said
"beyond eight units of O negative, it should persists continuing with it even if type specific cross match blood arrived" - I believe eight units of PRBCs not Whole (dose it make sense? Regarding dilution); our Professor in his lecture at the PGY1 mentioned, you can return to patient type specific blood group after 1 month from the last transfusion of O negative...

My scenario above, I put it in a puzzle, because you know we have shortages.

If I gave
2 units O negative
then got 3 A positive (his type specific cross matched), I can then give it to him, but in case I run out A positive and the bank told me we have only 5 left units of O positive - is it safe to give it all? Will this patient next transfusion - postop - will be O positive only? Is it the same treatment as O negative - should continue up to one month after last O positive?

Why it is so important to me? It is really complicated issue, and I just want a proper plan for less complications of blood transfusion!

In PRBCs = the rule is 1:1:1 (I know), while in whole blood especially recently prepared can deter 1:1:1 !!!

3 phases of cross match - phase 1 is about 99.8 (immediate phase) - Rapid method, while phase 2 takes like 45 minutes fir incomplete antibodies that phase 1 has no business with it, beside phase 2 detect antibodies in the Rh system - such phase level the bar of the screen to 99.94 %. If the cross match completed in phase 3 antiglobuline which takes 60 to 90 minutes, will level up the bar to 99.95%

I don't know, if I elaborated right?

I don't know, if I can solve that puzzle!

Thanks

 

[Volatile]

There are not absolute guidelines on when to switch to type specific blood. Generally, most will tell you to switch to the patients type specific blood once it’s available. It’s been awhile since I’ve read up on it, but I do recall some authors suggesting to continue with O neg blood once you’ve replaced a patients blood volume with O neg.

 

[coffeebythelake]

There are not absolute guidelines on when to switch to type specific blood. Generally, most will tell you to switch to the patients type specific blood once it’s available. It’s been awhile since I’ve read up on it, but I do recall some authors suggesting to continue with O neg blood once you’ve replaced a patients blood volume with O neg.

agree with this.
it really depends on how much donor plasma is present with the PRBC units.

 

[PTPoeny]

For the part of your question addressing several hours or a day later, if I give uncrossed RBCs I immediately get a new type and screen and transfuse according to those results as soon as the results are back.

I have never used whole blood, though. I suspect the concern is the antibodies contained within the plasma fraction as mentioned above. But again, I would think those would show up on a type and screen, so you could use data to support your transfusion strategy rather than a time-based strategy. But this is just a guess and I suspect that most civilian physicians in the US (ie, most of us on this site) aren't going to have great familiarity with whole blood transfusions.