bbbiker

We do not wash the RBCs. We do use CMV negative and irradiated units. One of the main reasons for washing RBCs would be to decrease the amount of potassium in the unit. We ensure the potassium is low by using the freshest unit available (always less than 7 days, usually 2-4 days).

We are also looking at using the TEG for CV surgery, and trauma. Is one instrument enough? We were told for platelet mapping you need 2 analyzers (4 channels). At your institution do they do platelet mapping (pre-op to look for platelet inhibition) in addition to the rapid TEG (intra and post-op)?

To quote Dr. John Hess of Baltimore Shock Trauma (2nd article below), "trauma tends to be a guy thing." A brief PubMed search yielded 2 articles on the topic. There may be more. Surg Gynecol Obstet. 1988 Sep;167(3):229-33. Use of Rh positive blood in emergency situations. Schmidt PJ, Leparc GF, Samia CT. Service Laboratories, Southwest Florida Blood Bank, Tampa. The emergency blood needs of 449 patients were met by supplying 1,717 uncrossmatched units of either red blood cells (RBC) type specific Whole Blood or group O RBC. The RBC were all Rh positive, and 601 units were transfused to 262 untyped patients. None of the patients presented with anti-Rh antibodies. Only 20 patients who were Rh negative received group O Rh positive RBC, and most of these patients were male. There were no acute hemolytic reactions or sensitizations of young females. Group O Rh positive RBC is our first choice to support patients with trauma who cannot wait for type specific or crossmatched blood. Those who do survive the emergency conditions can be reverted to blood of their own type without problem. Acceptance of Rh positive emergency transfusions by physicians giving emergency care can prevent unbalanced shortages in a regional blood supply system. J Trauma. 2005 Dec;59(6):1445-9. Safety of uncrossmatched type-O red cells for resuscitation from hemorrhagic shock. Dutton RP, Shih D, Edelman BB, Hess J, Scalea TM. R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. rdutton@umaryland.edu BACKGROUND: Uncrossmatched type-O packed red blood cells (UORBC) are recommended for immediate transfusion in hemorrhaging trauma patients. The potential for alloimmunization with this technique is controversial, and has been reported to be as high as 80%. We examined a 1-year experience with UORBC transfusion to determine the incidence of allergic reaction and alloimmunization. METHODS: Blood Bank and Trauma Registry databases for the year 2000 were linked to determine the incidence of UORBC use and the characteristics of patients, including the incidence of transfusion reactions and seroconversion of Rh-patients. Ten units of type-O, Rh+ blood (and two units of O-blood for women of childbearing age) were available for immediate transfusion, 30 to 45 minutes sooner than type-specific or crossmatched red blood cells. UORBC were administered to any patient with signs of severe hemorrhagic shock, at the discretion of the attending physician. RESULTS: In all, 480 trauma patients (out of 5,623 admitted) received transfusions of RBC, totaling 5,203 units. Five hundred eighty-one units of UORBC were given to 161 patients. Average Injury Severity Score in the UORBC cohort was 33.8. Patients receiving UORBC received an average of 16.9 total units of red blood cells, 14 units of plasma, and 10 units of platelets. Seventy-three patients died (45%). There were no acute hemolytic transfusion reactions observed in the patients who received UORBC. Four Rh-women received UORBC, all O-. Ten Rh-men received O+ blood, and only one developed antibodies to the Rh antigen. CONCLUSION: The need for UORBC is associated with significant injury and the need for subsequent massive transfusion. In this largest reported trauma series, the use of UORBC enabled rapid administration of red cells to hemorrhaging patients, without discernible risk for transfusion-related complications. The rate of seroconversion of Rh-patients is lower than reported in the literature, perhaps due to immune suppression associated with hemorrhagic shock.

I have not seen a patient with this, but the literature does look promising. In all the articles I found on Pub Med, it helped. In one article the patient's tics/OCD symptoms were so severe they had to do plasmapheresis under general anesthesia the first few times, but it worked and symptoms improved. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections - anesthetic implications and literature review. Sadhasivam S, Litman RS. Paediatr Anaesth. 2006 May;16(5):573-7.