Malcolm Needs

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Thanks Arno; that was really helpful.  Yes, very well indeed thanks!

Hello Malcolm, I hope you are doing good. I found this paper published in Blood in November 2023. The Cs a and Cs b Red Cell Antigens of the Cost Blood Group Collection Correspond to the HNA-3a and HNA-3b Neutrophil Antigens: Unexpected Twins with Implications for Sickle Cell Anemia - ScienceDirect 

ALLOHOPEfoundation.org  I just learned of this organization so wanted to share their name.  

ALLOHOPEfoundation.org I just learned of this organization so wanted to share their name.  

I was involved in one very unusual case (Win N, Needs M, Rahman S, Gold P, Ward S.  An unusual case of an acute haemolytic transfusion reaction caused by auto-anti-I.  Immunohematology 2011; 27 (3): 101-103.  DOI:  10.21307/immunohematology-2019-182.  

This was caused by the unit being removed from the storage fridge and immediately transfused.  If I remember correctly, however, because of the reaction, blood was put through a blood warmer on the ward as a precaution after this.  I doubt very much though that it would be something that would be done on a regular basis.

As you know a difficult question. The use of group O blood for non-O patients should be limited as soon as the ABO type is known, and ABO type specific given. There are some old admonitions to never transfuse type specific after X numbers of group O red cells or whole blood. This is nonsense, so do not follow this old precept.  Give only ABO type specific as soon as possible.
As for giving non-O blood to O patients when all other options are exhausted, I would only do this if death were imminent due to bleeding, not ever for routine transfusion.  There are case reports of no hemolysis in such situations, including the one below from my original mentors from half a century ago.  Accidental error but no consequences.  But giving non-O blood to O recipients has the potential to cause rapid death in many instances. We don't know why there are such varied responses.
 
Case Reports   Transfusion   . 1975 Nov-Dec;15(6):577-82.  doi: 10.1046/j.1537-2995.1975.15676082233.x. Unusual response to ABO incompatible blood transfusion
D H Buchholz, J R Bove PMID: 1198685   DOI: 10.1046/j.1537-2995.1975.15676082233.x Abstract
Three units of group A blood were inadvertently administered to a group O recipient during surgery without evidence of hemoglobinemia, hemoglobinuria, hypotension, disseminated intravascular coagulation, acute renal tubular necrosis, or other signs and symptoms of transfusion reaction. The recipient had normal concentrations of IgG, IgA, and IgM as well as complement (C3) prior to transfusion and anti-A agglutinins titered to 64 (titer of 128 by the antiglobulin technic). Seventeen hours following the transfusion, 28 per cent of the circulating red blood cells were group A (equivalent to 475 ml of packed cells); they were eliminated by day 5 without evidence of hemoglobinuria, hemoglobinemia or hyperbilirubinemia. Anti-A titers (antiglobulin) had risen from a posttransfusion low of 4 to 4,096 by day 10. After treatment of serum with 2-mercaptoethanol, however, hemolytic activity which was first noted on day 5 was lost and the antiglobulin titer dropped to 24 which suggested that most of the anti-A produced in response to the transfusion was IgM rather than IgG. The anti-A titer had dropped to essentialyy pretransfusion levels and the majority of anti-A present was IgM by day 91. The recipient suffered no untoward effects from the transfusion and was in good health three months following the transfusion.

Can not even Weak D type 1 patients be consistent in their ability to make anti-D?!??!  I still don't know why we got such different results than previously in gel. I verified that Ortho didn't change the anti-D clone in their gel cards between November and now. I guess this patient just wanted to mess with us.

In that case, I think that you would have been justified to have given "straightforward" D Positive blood in terms of a transfusion.  This is based on two papers from experts on the subject.

Sandler SG, Flegel WA, Westhoff CA, Denomme GA, Delany M, Keller MA, Johnson ST, Katz L, Queenan JT, Vassallo RR, Simon CD.  It's time to phase in RHD genotyping for patients with a serologic weak D phenotype.  Transfusion 2015; 55: 680-689.  DOI:  10.1111/trf.12941.

Sandler SG, Chen LN, Flegel WA.  Serological weak D phenotypes: a review and guidance for interpreting the RhD blood type using the RHD genotype.  British Journal of Haematology 2017; 179: 10-19.  DOI:  10.1111/bjh.14757.
My own mentor, Joyce Poole told me that Weak D Type 1 individuals rarely produce an anti-D after transfusion with D Positive blood - although she had come across about three or four cases WORLDWIDE!!!!!!

I was involved in one very unusual case (Win N, Needs M, Rahman S, Gold P, Ward S.  An unusual case of an acute haemolytic transfusion reaction caused by auto-anti-I.  Immunohematology 2011; 27 (3): 101-103.  DOI:  10.21307/immunohematology-2019-182.  

This was caused by the unit being removed from the storage fridge and immediately transfused.  If I remember correctly, however, because of the reaction, blood was put through a blood warmer on the ward as a precaution after this.  I doubt very much though that it would be something that would be done on a regular basis.

One of my own favourites is from Dr Brian McClelland MB ChB ND Linden FRCP(E) FRCPath, Consultant Haematologist, Scottish National Blood Transfusion Service, Edinburgh, UK, who said,

"Transfusion has risks, but bleeding to death is fatal."
I believe it was also him (although I could be wrong here) who said something along the lines of, "Giving perfectly compatible blood to a corpse is not a medical triumph!".

In that case, I think that you would have been justified to have given "straightforward" D Positive blood in terms of a transfusion.  This is based on two papers from experts on the subject.

Sandler SG, Flegel WA, Westhoff CA, Denomme GA, Delany M, Keller MA, Johnson ST, Katz L, Queenan JT, Vassallo RR, Simon CD.  It's time to phase in RHD genotyping for patients with a serologic weak D phenotype.  Transfusion 2015; 55: 680-689.  DOI:  10.1111/trf.12941.

Sandler SG, Chen LN, Flegel WA.  Serological weak D phenotypes: a review and guidance for interpreting the RhD blood type using the RHD genotype.  British Journal of Haematology 2017; 179: 10-19.  DOI:  10.1111/bjh.14757.
My own mentor, Joyce Poole told me that Weak D Type 1 individuals rarely produce an anti-D after transfusion with D Positive blood - although she had come across about three or four cases WORLDWIDE!!!!!!

Maybe some of these references are helpful. 
7. Selleng K, Jenichen G, Denker K, et al. Emergency transfusion of patients with unknown blood type with blood group O Rhesus D positive red blood cell concentrates: A prospective, single-centre, observational study. Lancet Haematol 2017;4:e218-24.
8. Frohn C, Dümbgen L, Brand JM, et al. Probability of anti-D development in D– patients receiving D+ RBCs. Transfusion 2003;43:893-8.
9. Gonzalez-Porras JR, Graciani IF, Perez-Simon JA, et al. Prospective evaluation of a transfusion policy of D+ red blood cells into D– patients. Transfusion 2008;48:1318-24.
10. Tchakarov A, Hobbs R, Bai Y. Transfusion of D+ red blood cells to D– individuals in trauma situations. Immunohematology 2014;30:149-52.
11. Yazer MH, Triulzi DJ. Detection of anti-D in D– recipients transfused with D+ red blood cells. Transfusion 2007;47:2197-201.
12. Burin des Roziers N, Ibanez C, Samuel D, et al. Rare and transient anti-D antibody response in D(–) liver transplant recipients transfused with D(+) red blood cells. Vox Sang 2016;111:107-10.
13. Yuan S, Davis R, Lu Q, et al. Low risk of alloimmunization to the D antigen in D– orthotopic liver transplant recipients receiving D+ RBCs perioperatively. Transfusion 2008;48:2653-5.
14. Schonewille H, Haak HL, van Zijl AM. Alloimmunization after blood transfusion in patients with hematologic and oncologic diseases. Transfusion 1999;39:763-71.
15. Goodell PP, Uhl L, Mohammed M, Powers AA. Risk of hemolytic transfusion reactions following emergency-release RBC transfusion. Am J Clin Pathol 2010;134:202-6.
From this: Association Bulletin #19-02 - Recommendations on the Use of Group O Red Blood Cells (Revised) (aabb.org)

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Just to give credit where credit is due.  
“Obtaining compatible blood for a corpse is not a therapeutic triumph.”  Ed Snyder, MD (Yale University) ISBTS meeting (Edinburgh) September 6, 2002

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She came back as a weak D type 1.  Her second specimen (the one we sent out) typed similarly to the first in tube--neg at IS and 37C but pos at AHG. 

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I'm paraphrasing quite a bit but I was one time told by a blood banker I highly respected; "Get the ABO right first and foremost, then take care of the rest the best you can!" 
Another favorite of mine comes from an ER Physician, probably the best I ever worked with.  "Halitosis is better than no tosis!"  I'm sure that applies similarly to a severely bleeding patient.