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Well, the high potassium is undoubtedly a factor, in particular as it is a cardiac case. All units in the UK are leukodepleted, but I wouldn't have thought that "unleukodepleted" blood should be of too much concern in this case. The difference in the Rh type would be of no concern to me whatsoever. The baby's immune system would be immature, and so it is highly unlikely that the "foreign" Rh antigens would cause immunisation. Indeed, exposure to these "foreign" Rh antigens may be advantageous in a way, as there is the possibility, as this age, that these may lead to "accomodation", meaning that the baby may never produce antibodies against these antigens, but this has not been proved, as far as I know.

Thank you so much,Malcom!

Thank you,Malcom!I'm finally enlightened !

We have been doing second ABO/Rh types on transfusion candidates with no previous history since 2002! We use previously drawn hematology specimens whenever possible. Since nursing does some of our draws, we send a small pink top tube to the floor to be used (we are the only department allowed to order and use these tubes) for the "confirm type". We use parafilm around the cap so we can make it "tamper proof" to some extent. Before we did this step, industrious people would draw two tubes at the same time and save one, waiting for our request of a second draw. They would pour over the saved tube into our special tube....now they can't. We do second types on all ABO types, we don't exclude type O.....they too can be WBIT.....which could affect other lab departments.....we let them know if we find mistypes. We also don't exclude emergency transfusion......that is when the most errors happen because people seem to lose their minds in high stress situations. We stick with type O until the confirm type has been drawn. We tried the two signatures on the tube route, but found they were just grabbing anyone and having them sign the tube whether they witnessed the draw or not. Fun times in the blood bank! :)

As the vast majority of hospitals (and Reference Laboratories) in the UK use column agglutination technology and automation, it is almost impossible to perform a second ABO without either a second D type or wasting a column or more than one column. But, my point was that, if a patient groups as O the first time, and A, B or AB the second time, then, it is obvious that either the first bleed or the second bleed was WBIT. Why should it be assumed that, if the person types as group O the first time, that is both correct and that it is automatically safe to give group O blood? If anyone does, I advise them to read the posts of Dr Neil Blumberg on ABO mismatched, but apparently compatible transfusions.

Sorry, but to my mind, these patients should also be typed twice. Yes, they can be given group O blood (almost always safely), but what if it is a WBIT, and the D typing is wrong because of it, or an antibody is missed because the "real" patient is group O with, say, an anti-K, while the other patient bled is group O, with no antibodies present. In addition, and incredibly rarely, what if the "real" patient is an Oh, while the patient bled is an ordinary group O.