Exsanguination with rare blood (Duffy)

[lmnopeieio]

I'm an ER guy, rural work mostly. I've been scratching my head and reading hematology / transfusion text and other online publications. I still have no answer.

?If I had a pt bleeding to death ( quickly, masively, internal bleed , upper vs lower GI tract unknown. Hmg 12 48 hours prior, to 5 acutely, he has duffy antibodies. If I gave O- (or even type specific), would it help, hurt, or a medical misadventure leading to iatrogenic death.

I've encountered rare blood in the rural lands, but some helicopters fly fast. It's going to happen someday and I'm unclear as to my ability to give the patient the best chance.

Or hold my breath and pray the duffy will arive ( 4 hour away )?

---

Members don't see this ad.

 

[wholeheartedly]

I'm an ER guy, rural work mostly. I've been scratching my head and reading hematology / transfusion text and other online publications. I still have no answer.

?If I had a pt bleeding to death ( quickly, masively, internal bleed , upper vs lower GI tract unknown. Hmg 12 48 hours prior, to 5 acutely, he has duffy antibodies. If I gave O- (or even type specific), would it help, hurt, or a medical misadventure leading to iatrogenic death.

I've encountered rare blood in the rural lands, but some helicopters fly fast. It's going to happen someday and I'm unclear as to my ability to give the patient the best chance.

Or hold my breath and pray the duffy will arive ( 4 hour away )?

I worked in the blood bank at major level1 trauma center for three years where we run into this sort of scenario sometimes. Plus we have some really sick patients that come with a way more complicated mess of antibodies than just a Duffy that can take hours to work up. Generally when you call for blood on a patient like this, the lab folks are going to be in touch with a pathologist while trying to find something that will work for you.

If you don't even have time to wait to touch base with them on what the best strategy will be given their medical issue, strength of the reaction against the antibody, what the blood bank has available, etc we do send O neg or type specific and hope that the patient's rate of blood loss is fast enough to prevent them mounting an immune response until we can get you cross matched antigen compatible blood. Its a calculated risk, but I've seen it happen quite a bit.

Do you have an in-house blood bank? If you do, the lab scientists do have a bit of an algorithm to increase their odds of finding a compatible unit. But I did my training at a small critical access hospital and I think we generally only stocked 30 units total of all types, so it can be pretty limiting. If you're going to fly the patient out to another institution you can ask your lab to get in touch with the receiving lab so they can get a jump on some of the testing. They won't have cross matched units when the patient arrives but can have Duffy negative units ready for emergent use.

 

[random1234]

If I'm not mistaken, if this is the patient's first blood transfusion, then you can safely give O- (that might have Duffy antigens) because people don't develop antibodies to the non A/B antigens until after they've been exposed. So if this is pt's first transfusion, he will be okay with O- blood with Duffy antigens. However, if this is the pt's second transfusion, then he could mount an attack... But if this is life or death and 2nd transfusion, go ahead and give the O- blood. Acute symptoms of blood mismatch are fever and back pain from kidney overload but rarely does it result in death...

 

[Arcan57]

From wife (hematologist), Duffy is considered moderate for hemolysis and even with known antibodies it sounds like risks outweigh benefits.