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I'll add that this policy is in keeping with the guidelines of the AABB and Red Cross. If, in the US, we used O neg instead of O pos, we certainly would not have enough O neg left for known Rh neg patients or those with anti-D. We are on allotment for O neg and can't get more than our quota without the supplier's medical director approving a medical release. No change in sight. We can't trade the certain harm to those patients for the potential harm for the trauma patients who are 85% likely to be Rh pos, usually male, unlikely to make anti-D, and usually not likely to require emergency transfusion more than once in their lives. I'll admit that I am having some of the same qualms with the new policies to use O pos whole blood for traumas of any age and gender. Their arguments about the modern treatment of HDFN are probably right, but they are harder to accept for me. We had to start keeping O pos on our helicopters last year because we couldn't manage the O neg rotations anymore. Same risk as the whole blood argument. The only young female transported got the unit of liquid plasma and not O pos red cells.

It's pretty likely it's her blood because baby has a weak D Rh type but, yes, we thought of that.

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I'm sure I know the answer but I have to ask, did you test a second sample drawn at a different time? I'm sure the 1st thing you did was confirm right patient, right blood but had to ask.

I've said it before, inertia is the strongest force in the universe. From my 35+ years as a blood banker and supervisor of both donor services and transfusion services, I have come to the conclusion that, as a general rule, blood bankers are extremely slow to change when not resisting it completely. This appears to be especially true if they are not actively involved in the change or keeping up on the literature. I saw a great may changes during my tenure and not all of them were comfortable at first. Giving O Pos blood to massive bleeds was just one of them. The data supports it, no matter what our long held concerns and fears try to tell us. Many of those long held fears and concerns were primarily theoretical, especially in how prevalent and disastrous the outcomes would be. I have a number of stories to prove my point but I think I'll stop now and step off my soapbox.

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O negs are still used in excess of their numbers in the general population. I've worked on both the donor side and the transfusion side. The pressure on O neg donors is huge. They are asked to donate as often as possible. We owe it to these donors to be good stewards of their donation.

Yes, I didn't think it was directly pertinent to your case Mabel.

I am aware of this for the Alba anti-D but never had the reference, so thanks for that. That reagent, with its potentiators, definitely will pick up i on cord cells and, we suspect, the occasional i adult. It is worse if it is cold. It disappears at 37C so is pretty obviously not D. We use it because it has a similar sensitivity for weak D to Ortho gel (usually!!!).

I don't think this is the reason in the case you describe, particularly in the case of the baby's D typing, but, just to remind people, a monoclonal anti-D taken straight from the fridge, and not allowed to come to room temperature before used for testing, can lead to false positive results. See Thorpe SJ, Boult CE, Stevenson FK, Scott ML, Sutherland J, Spellerberg MB, Natvig JB, Thompson KM. Cold agglutinin activity is common among human monoclonal IgM Rh system antibodies using the V4-34 heavy chain variable gene segment. Transfusion 1997; 37: 1111-1116. DOI: 10.1046/j.1537-2995.1997.37111298088038.x., and Thorpe SJ, Ball C, Fox B, Thompson KM, Thorpe R, Bristow A. Anti-D and anti-i activities are inseparable in V4-34-encoded monoclonal anti-D: the same framework 1 residues are required for both activities. Transfusion 2008; 48: 930-940. DOI: 10.1111/j.1537-2995.2007.01624.x.

"Though giving even one anti D when you didn’t need to seems like harm to patient. Would have been thought that ways years ago. Thanks for your words of comfort." You are STILL not giving ANTI-D Kym; you are giving D Positive red cells. The other thing is that, within the White populations, but more so in the Asian populations, there is a very good chance that giving group O, rr blood will stimulate the production of an anti-c (IF any Rh antibody is stimulated), and that can be just as "dangerous".

That’s reassuring. I hope you are correct. Goes against all the care and concern we used to have about giving blood before. “Unknown” by definition means just that. Nothing about their transfusion history or reactions is known so why oneg to begin with. I think the concern for a bad transfusion reaction or something that could affect their life (future emergency giving antigen positive to a pt with a significant antibody and cause harm) is just not there anymore it appears to me. Wonder why we tried so hard before. Maybe better care after transfusion reactions make it less dangerous 🤷‍♀️. I know I have no say. But risk giving opos when you have well stocked oneg? I just don’t get what we are saving it for. I always understood emergency as in no oneg available. But to plan on not caring is kind of mind boggling. So yes. I hope we have ok experience too. Though giving even one anti D when you didn’t need to seems like harm to patient. Would have been thought that ways years ago. Thanks for your words of comfort.

We have an OB patient in to deliver who typed in gel anti-D as a solid 2+. Control is neg. We have typed her 3 times before in recent years using the same methods and she has always tested D negative. Most recent A Neg type was last November. Now with Albaclone anti-D, she is negative at IS and 37 but 1+ at AHG. Her prior baby was Rh neg so no attempted fetal screen test then. This baby is 1+ at IS with the Albaclone anti-D and 3+ at 37C and AHG. We don't usually run cord blood Rh types in gel. We will recommend the patient be sent for molecular testing. My question is what would make her D antigen strength change so much (or make Ortho's gel cards change their sensitivity that much)? I know leukemia can weaken D antigens, but she seems perfectly healthy. No bone marrow transplants. No recent transfusions. No reason to believe she isn't the same patient as before. I can't find any references besides Issitt mentioning changes in D reaction strength. Issitt mostly mentions the Leukemia aspect, but I feel like I have heard of other situations. She had shingles in April and was treated with ACYLOVIR for what that's worth. We are treating her as Rh negative for now.

We are a remote 280+ bed level 2 trauma center. After reading about many mass casualty incidents not being able to get all the patients registered before they need transfusion, I created a process and form for taking a box of blood to ED and handing it out while recording some way to know which patient got it. Not sure it will work. Would depend on a supervisor or someone available to do this as everyone in the BB will be super busy already. I had to come to the conclusion that a Las Vegas level shooting here would exceed our blood supply capacity and some patients just wouldn't be able to get transfused. Hard reality of being rural. For more manageable events, we would use our MTP and emergency release processes as best we could. One challenge would be knowing where patients were being sent in our system of 3 critical access and one bigger hospital which are all 20-60 miles apart. The big one is not in the center of the others. We have started sending a cooler of 2 units of plasma to our "full trauma" activations (over about age 5). If they are really bad and become MTPs, they need the plasma. If it gets wasted it is not as dire as wasting O pos or O neg RBCs. This requires no decisions on which Rh type to give for males and females. We keep 2 A plasma thawed at all times for this.

We give O pos for all uncrossmatched blood orders for males and females over 50. We've done it for a couple of decades. We avoid it if the recipient is known to have anti-D already. We have seen very few make anti-D.

On the contrary - The quality IS there and we are saving lives better than before. Statistics show that: 1) - most "Trauma" MTP patients are male... So, making anti-D is the least of their worries - like our team always says......they have to LIVE to have a problem. And, 2) - it is not nearly as likely for RH neg females who are bleeding excessively and get Rh pos units to make anti-D as you may think........and the quality of care for the few females who do get pregnant after an Rhpos transfusion AND make anti-D is so much better now. Again - they have to LIVE through the traumatic episode to make anti-D and then get pregnant and have a baby. IF all that is possible after their trauma experience I think they'll be thrilled and having anti-D will be a non-issue. You might want to read the articles I posted above in this thread. They're really helpful.

Typically, when you have a limited blood inventory, the BB response to a mass casualty incident depends on the inventory and the incident. We have two stages here (500+ bed level 1 trauma urban hosp): an ED surge where they are expecting many patients to the ED at one time that are expected to be critically/severely injured, and the actual MCI which is when they expect more than 10 patients. The BB response to an MCI is to get 5 coolers of uncrossmatched products ready and have them available to be picked up, and basically keep that amount at the ready until we are cleared. We do 4 rbcs and 2 plasma per cooler, so this is a good amount of product. As a smaller community hospital, you may not have 20 O pos red cells to set aside like that, so you have to make up what works for you. Once initial coolers are ready, we start calling our local suppliers to get as much product to us as possible as soon as possible. If things go awry you'll need to be restocked sooner than later, so better get those people mobilized and couriers on their way to you! That can be difficult if the hospital is in lockdown due to the emergency, so we also work with our Security team to let those couriers in the doors. These are the first things I think of, hope this helps!

Depends on the distance from transfusion service to ED/OR. I assume you are not planning on having the cooler or refrigerator with blood in the ED on a routine basis, only when the mass casualty event occurs? Are you the only hospital in the area, or are there other hospitals with level I or II trauma capability?

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