Emergency release previous known history

[kell23]

Hi, Just wondering what opinions others have about emergency releasing blood to a previous known historical ABO/RH type without having a specimen to verify the blood type. With the 'bad' practices of our ER with labeling specimens, I feel O NEG should be given until the patient is verified and an ABO/RH performed. How do others handle this situation?

Thanks.

[Malcolm Needs ☆]

Under no cricumstances would I give out anything but O D Negative blood for a woman (or O D Positive for a male) unless I had a sample to check.

Even if the ER said that there was identification on the patient, such as a credit card or something like that, how would they know that the credit card had not been stolen from the genuine patient who had been in before, by a dishonest patient who had come into the ER?

It is a recipe for disaster if any other blood were to be issued.

Of course, one could always ask if such people deserve ABO compatible blood, but that is another question altogether...............................................................

Edited June 10, 2009 by Malcolm Needs

[clmergen]

We only issue type O blood according to our Emergency Issue policy. The only thing we do try to honor are any antibodies found on the historical search, if time permits. But we rarely have a name when the uncrossmatched units are issued so it isn't a circumstance that we run into often.

[Mary**]

The use of historical types is not permitted.

[John C. Staley]

The standard, as long as I can remember, has been "no blood products released based on historical information". This was one rule I never even considered skirting!

[pluto]

I think we are all going to agree on this one

[Eagle Eye]

O pos to males & O neg to child bearing age female. If we have a known history of antibody then we try to give antigen negative blood if available in inventory. Some cases would use blood bank knoweldge and take chance if no antigen neg units are avilable. eg. if H/O anti-C or anti-E, give Rh O neg, if H/O anti-c give O pos etc.

NEVER ISSUE TYPE SPECIFIC BASED ON HISTORICAL TYPE.

[kell23]

Thanks everyone who responded. I hope the techs I work with saw these posts. We did not give out type specific to our emergency patient, however one tech thought it was 'ok' to take the historical blood type. Good thing the other techs didn't take this techs advice. Thanks again everyone.

[vocs00]

Hi,

At our institution we give all females of child bearing are o negs and all males o pos. Hope this helps

[Cathy]

Thanks everyone who responded. I hope the techs I work with saw these posts. We did not give out type specific to our emergency patient, however one tech thought it was 'ok' to take the historical blood type. Good thing the other techs didn't take this techs advice. Thanks again everyone.

Never use the historical type for issuing non-group O red cells. A simple registration error, now or when this patient was seen in the past is a recipe for disaster. Never, never, never give type specific until you have done a type (or two depending on your policy).

[Jaimie Nicholson]

What's all this about giving O Pos to male patients? What if they start making anti-D and have a delayed transfusion reaction? Lucky for me I'm Rh(D) positive, but still... I demand that we men should have equal rights to O neg emergency blood!

Edit: that being said, yeah, we only issue group specific blood if we have done a group on a current sample, otherwise we give O neg. To both genders

Edited June 17, 2009 by Jaimie Nicholson
adding relevant content ;)

[luhubert]

Hi, Just wondering what opinions others have about emergency releasing blood to a previous known historical ABO/RH type without having a specimen to verify the blood type. With the 'bad' practices of our ER with labeling specimens, I feel O NEG should be given until the patient is verified and an ABO/RH performed. How do others handle this situation?

Thanks.

I think you must NOT accept a historical blood type without confirming it, especially in an emergent situation. I have many stories to share about scary situations involving people using other people's identification, tubes being mislabeled, admission mistakes, etc. I won't bore you by relating them here but my experience has certainly convinced me that historical blood types should never be used without confirmation.

[Bill Sinn]

OK, but what about this scenario (and it has happened). Patient has been inpatient for some while, crossmatches done every 3 days.. patient is A Pos.

Early AM, after previous crossmatch sample has expired, patient needs blood emergently. Issue uncrossed O neg or uncrossed A pos that a few hours earlier was completely acceptable for this patient?

[eric1980]

OK, but what about this scenario (and it has happened). Patient has been inpatient for some while, crossmatches done every 3 days.. patient is A Pos.

Early AM, after previous crossmatch sample has expired, patient needs blood emergently. Issue uncrossed O neg or uncrossed A pos that a few hours earlier was completely acceptable for this patient?

My BB policy is to issue O Neg RBC for childbearing-aged females and O Pos to males.

But personally, I really do not see why we would want to waste precious O Neg RBCs if there are at least 2 specimens sent in the patient's history.

[Malcolm Needs ☆]

OK, but what about this scenario (and it has happened). Patient has been inpatient for some while, crossmatches done every 3 days.. patient is A Pos.

Early AM, after previous crossmatch sample has expired, patient needs blood emergently. Issue uncrossed O neg or uncrossed A pos that a few hours earlier was completely acceptable for this patient?

I see where you are coming from and would be quite happy to give uncrossmatched A Positive in this particular scenario. But I see this scenario as completely different from a patient coming in through Casualty off the street.

After the emercency has dies down, I might/would ask a few awkward questions as to why a fresh sample had not been sent, when the doctors looking after the patient must know (under the circumstances you describe) when a fresh sample is due!

In the UK, if a patient is given uncrossmatched blood, it is ALWAYS the responsibility of the requesting doctor. Sometimes it helps to remind them when they actually ask for uncrossmatched blood (you would be amazed how many times there is suddenly enough time to perform a crossmatch) and sometimes afterwards, when you hear this enormous gulp down the telephone.

[clmergen]

In this case I would issue crossmatched A pos blood using an expired specimen and complete a Deviation Report.

[RR1]

I would have thought that in a real emergency situation the last thing on the clinicians mind would be that the sample was a few hours out of time. The clinicians have a hard time too trying to keep their patients alive.

I agree with clmergen on using the old specimen and completing a deviation report.

[JOANBALONE]

I disagree about using the old sample. The SOP is there to avoid senariios we haven't even thought. Such as, the doctor telephones that he needs emergency release on Joe Blow, little did you know he was talking about Joe Blow's roommate. Things are crasy during emergencies.

Unless we have no group O blood on the shelf I will give group O even if the sample is just 1 second expired. The computer system we have will not allow me to use the old sample unless I jump through hoops, and I am getting old. We have the luxury of having plenty of group O blood on the shelf, giving a few O units to a non-O person is not a big deal. Usually the docs can get a sample to me in just a few minutes and type specific blood can be issued a few minutes later. To me the big deal is not giving someone group O blood when they are not group O, the big deal is the antibody screen.

By the way, I once had a truama roll into the ER, the docs want two units O negative emergency release. One of my associates looked up his history and he had an anti-e. All of a sudden the docs were willing to wait for crossmatched blood.

[Malcolm Needs ☆]

I would have thought that in a real emergency situation the last thing on the clinicians mind would be that the sample was a few hours out of time. The clinicians have a hard time too trying to keep their patients alive.

I agree with clmergen on using the old specimen and completing a deviation report.

I agree entirely with you RR1. IN the emergency situation, it probably is the last thing on their minds; which is exactly why I would ask awkward questions as to why a fresh sample was not available before the emergency arose (in the case quoted above).

[Malcolm Needs ☆]

I disagree about using the old sample. The SOP is there to avoid senariios we haven't even thought. Such as, the doctor telephones that he needs emergency release on Joe Blow, little did you know he was talking about Joe Blow's roommate. Things are crasy during emergencies.

Unless we have no group O blood on the shelf I will give group O even if the sample is just 1 second expired. The computer system we have will not allow me to use the old sample unless I jump through hoops, and I am getting old. We have the luxury of having plenty of group O blood on the shelf, giving a few O units to a non-O person is not a big deal. Usually the docs can get a sample to me in just a few minutes and type specific blood can be issued a few minutes later. To me the big deal is not giving someone group O blood when they are not group O, the big deal is the antibody screen.

By the way, I once had a truama roll into the ER, the docs want two units O negative emergency release. One of my associates looked up his history and he had an anti-e. All of a sudden the docs were willing to wait for crossmatched blood.

I can see where you are coming from JOANBALONE, but even if the medics did get you a sample in minutes, and you were able to give type specific blood, you would not have time to detect new atypical alloantibodies, so would you not be back to square one?

[jcdayaz]

Wow. Wow. I think I have several points to make on this post. Reader BEWARE! :)

First and foremost I would NEVER issue type specific blood even in an emergency situation on a 1 second expired sample. NEVER! Anything issued until a new crossmatch specimen could be obtained would be O Neg on everyone with an Emergency Release form signed by the physician--depending on inventory. If O Neg's are in short supply (cancelling surgeries and notifying ER level) we would try to switch a male recipient to O Pos with Pathologist approval.

Jaimie--I take it in New Zealand you have an endless supply of O Negs? I am jealous! We would start a male with O Negs but if the situation seemed like it would be one of massive transfusion--we would switch to O Pos. The point behind giving a woman of childbearing age O Negs is that if she becomes pregnant in the future it saves the fetus potential harm from an Anti-D.

[jkdmendoza]

in our hospital we give O NEG blood though the patient have a known blood type for emergency release, until they can give a blood specimen for blood typing and then do the emergency cross-match for the succeeding blood units to the specific blood type