Trauma Case

[Idiopathic]

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To answer your followup question, there's no need to "stick with" uncrossed type O blood after X number of units if you go down the massive transfusion road.

This is not true. You should continue to transfuse type nonspecific blood once 4(?) units are given in an initial resuscitation, and then you should draw a new T+C, at least thats what the book says.

As far as O+, all you are going to do is immunize the patient against Rh antigen which shouldnt matter since this guy is unlikely to have an Rh(+) passenger along for the ride at some time

 

[pgg]

This is not true. You should continue to transfuse type nonspecific blood once 4(?) units are given in an initial resuscitation, and then you should draw a new T+C, at least thats what the book says.

As I understand it, this is dogma, a holdover from the days of whole blood transfusions, and doesn't apply to RBC component transfusions. I have a couple references at work, will post them tomorrow.

 

[pgg]

As I understand it, this is dogma, a holdover from the days of whole blood transfusions, and doesn't apply to RBC component transfusions. I have a couple references at work, will post them tomorrow.

From Transfusion Medicine: A Clinical Guide p 64

a throwback to the days when whole blood was much more common than it is now. If you give a group B person group O whole blood, you're giving anti-A,B antibodies. If you've given many units, then you don't want to give him group B blood (whole or RBCS), because the anti-B will cause some hemolysis of the group B red cells. We don't use whole blood often anymore, so this is rarely an issue. When we give group O RBCS, there is hardly any plasma in the unit, so anti-A,B is not a concern. So, if you're starting with group O RBCS, then are able to switch to group B, just do it. Hemolysis is NOT a problem here.

I've got one more textbook here that says the same thing, looking for it now.

 

[BLADEMDA]

substituted.

Emergency Transfusion Requests. In very urgent situations blood will be issued before a crossmatch is performed. The requesting physician must submit a completed "Emergency Request for Uncrossmatched Blood" (BB:45) form certifying the urgent nature of the request. If the patient's type is unknown and an acceptable sample is not available for testing, as many as four units of Group O, Rh negative red blood cells will be issued. If, after these units have been issued, a sample is still not available and additional blood is requested then:
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a) Group O, Rh negative red blood cells will be issued to all females not past child bearing age (<50 years) and for those patients with a known history of Rh sensitization.
b) All other patients will receive Group O Rh negative red blood cells only if inventory is adequate. Otherwise, they will be issued Group O Rh positive red blood cells.
c) Patients who have received 12 or fewer units of Group O red blood cells may be switched to blood of their own group. After more than 12 units of group O blood, only group O will be issued until the absence of isohemagglutinins is documented in a posttransfusion patient specimen. In order to prevent depletion of group O blood inventory, only 4 uncrossmatched units are released for one patient at one time, and a switch to type specific blood should be made as soon as possible.
d) If a current sample (< 3 days old) is available for testing, then uncrossmatched ABO compatible units may be available in approximately five minutes.
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1. Schedule. Requests for blood will be filled as follows:
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Time Available

Emergency (no crossmatch) Immediately
Immediate spin crossmatch 15 minutes
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An immediate spin crossmatch confirms ABO compatibility between the donor and recipient. This technique is routinely used for compatibility testing whenever a fully tested type and screen patient specimen (with negative antibody screen) is in the blood bank, and the patient has no history of alloantibodies.
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Anti-human globulin crossmatch 2-4 hours
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An antihuman globulin crossmatch is performed on specimens from patients with alloantibodies, or a history of alloantibodies.
​

 

[BLADEMDA]

http://books.google.com/books?id=tg...m=6&sqi=2&ved=0CCgQ6AEwBQ#v=onepage&q&f=false


So, is the answer 2 units of Whole Blood and 12 Units of PRBCs (O-)? Plankton would say we don;y know the answer but the UVA policy seems reasonable.

1. UVA gives you 4 units of O- or O+ emergency release blood

2. You can get more if needed but partial cross matched avail in 15 min

3. You can give up to 12 units of emergency release unmatched blood but after that amount you can't go to type specific blood until the blood bank gives the okay

I know some centers wouldn't agree to the above and may recommend switching to type specific blood regardless of the number of units of emergency release given to the patient.

 

[BLADEMDA]

You see it turns out the blood bank guys love to sit around and debate the topic of when to switch back to type specific blood. They can't agree even after two six packs:

We are Level 1 trauma center and our policy for massive transfusion protocol states that, release O Positive unxm rbc for male patient. When specimen is received and if patient is Rh negative, we continue giving Rh positive xm or unxm rbc until rapid transfusion continues, eg. operating room but switch to Rh negative when patient is more stable and usage is lesser in ICU. For ABO, as soon as blood group is available we switch to patient ABO.