B+ donor to O+ patient

[emadlabs]

Can I use incompatible different blood group in case of emergency like B+ to O+ pt or AB+ to O+ due to shortage of blood?

of course you mustn,t give pateint O Pos any blood except O Pos or O Neg only, because whole blood contains in plasma Anti-A & Anti-B which reaction with antigen B in group B or with Antigen A in group A so with blood AB

Public rule you can give O blood ( R.B.C) to A , B , or AB Patient

and you can give A , B , & O to AB Patient

[Eoin]

Please find a back-up blood supply somewhere near that can get units to you quickly (ABO Compatible). Incidentally, there are plenty of ABO compatibility charts for RBCs, and indeed other blood products in the literature. Unless you like the inside of a cell, do not deviate from this.

You can hold a patient for a while on plasma expanders (colloids etc) & then push in the red cells. I see recent articles on cold saline to induce hypothermia for cardiac arrest patients and improved survival (up from 17% to 28%). Just wondering if cold fluids would help shut down circulation a bit to reduce loss and perfusion requirements as well?

Any thoughts folks?

Cheers

Eoin

[newBB]

Why pool them? Cross-match and issue without pooling. You would be asking for trouble otherwise.

Steve

i want to pooled the small peditric units . usually we have left out peditric units no one want to use them for adult cuase of the size . i cannot assigned to patient 4 units of pediatric units . nurses complain . if comatamination is a concern what about when we are pooling cryo and platlets units ? same procdure

thanks

[yaya]

if the patients blood was washed out ( massive transfusion ) like infusion of 10 - 15 units of the same group then different group what will happen ?:confused:

[RR1]

i want to pooled the small peditric units . usually we have left out peditric units no one want to use them for adult cuase of the size . i cannot assigned to patient 4 units of pediatric units . nurses complain . if comatamination is a concern what about when we are pooling cryo and platlets units ? same procdure

thanks

You have to also think about whether it is good practice to be increasing donor exposure for the intended recipient. If this is a cost issue -then you need to review how many paediatric units you hold to minimise wastage.

If you have to issue these units- then leave them intact, and if the nurses complain-you explain this is the safest option.

In the UK we are lucky that our Cryo is pooled by the blood centre during initial processing, but when we had individual 30-50ml units these were thawed and issued as 10-20 small individual packs and never pooled by the labs.

[KKidd]

:handshake:handshake:handshake

Unless you are dealing with a massive transfusion, I have one comment. If the patient has a transfusion reaction, it is much simpler if they are not receiving pooled RBCs. I would hate to do a workup for multiple units if not absolutely necessary.

[JOANBALONE]

Hi newBB,

I have never had to face this problem. We usually use all our pediatric units and have plenty of normal, adult size unit to go around. However, even if we had several small, pediatric units soon to expire we would not use them for an adult. Is it possible to manage your pediatric stock better so you are not left with a lot of small units? Some hospitals will remove a small amount from a regular unit for a baby and continue to use the remainder for an adult.

[JOANBALONE]

Hi yaya,

I have read accounts of this actually happening in remote areas in which group O blood was not available. They first tried switching plasma types and then blood types. I am not sure how this turned out for the patient (I think the patient died from injuries). It must have been a very desperate situation to try this.

Edited October 11, 2010 by JOANBALONE

[John C. Staley]

Amazing. I go on vacation for 2 weeks and come back to a thread like this.

Remember that not everyone has a large and ready supply of blood. If the choice is standing and watching the patient die or creative blood banking then a little ingenuity (sp?) may be in order. I see no problem at all in giving adults the left overs from pedi units that are compatible and in date. I don't think I would waste the time pooling them though.

As for ABO incompatible units, certainly avoid them at all cost but if the patient is bleeding briskly the units may just keep them alive until compatible units can be found. Make sure the physician knows what they are in for and let them make the final decision.

[JOANBALONE]

You're such a cowboy John (would love to add a smiley face but have no clue).

[Eagle Eye]

I would not pool the units. I would issue each unit separately with my MD approval.

[yaya]

thanks JOANBALONE for replay and as you said i will never try unless it is a desperate situation

[newBB]

if the patients blood was washed out ( massive transfusion ) like infusion of 10 - 15 units of the same group then different group what will happen ?:confused:

i never said diffrent blood group my question is if i have 4 units of O ( pediatic volum) and after i xmatched them . is it possible to pooled them to make it 200 ml . if not what is the reason . since we pooled the cryo and platlets . at my work we are not pooling the PRBC but i wonder why not . thank you i guess i scared you all !! sorry

[newBB]

Hi newBB,

I have never had to face this problem. We usually use all our pediatric units and have plenty of normal, adult size unit to go around. However, even if we had several small, pediatric units soon to expire we would not use them for an adult. Is it possible to manage your pediatric stock better so you are not left with a lot of small units? Some hospitals will remove a small amount from a regular unit for a baby and continue to use the remainder for an adult.

Thank you for your answer . we need to better manage our pediatric units . cuase we have 7 units left almost 70 ml each not older than 10 days we usually throw them . is a waste cause the doctor want to have full unit of PRBC . any advise how can we better manage our pediatic units ? we issue group matched PRBC .

[John C. Staley]

There is a phrase here that may be appropriate. "It's the cost of doing business."

I would not transfuse partial units to a patient simply as an inventory control measure. Emergency situations are an entirely different story. I realize that no one likes to waste products but sometimes there is not a viable alternative. I don't know of any regulations preventing doing this and I've never been in a postion to consider it. If my inventory control became that critical there is no telling what measures I would be willing to consider. I am confident that I would not pool the RBCs. Can't really say why not other than it just does not seem like the right thing to do.

:blahblah:

[bduff]

The only reason to pool the units would be to please the nurses.... You are still exposing the patient to a lot more donors which I wouldn't like as a patient. If you could get ped. blood that all came from the same donor that would be the best way to control your inventory. You could give out the 4 or so separate units but only expose them to one donor. As far as pooling we are getting as far away from that as possible. There is too much risk of contamination. I would say tough to the nurses!

[newBB]

thank you very much

[newBB]

you mentioned a good point ! Thanks

[JOANBALONE]

Some hospitals dedicate one unit to one baby, some assign multiple babies to one unit and yet others assign no babies to any unit. There is no requirement to assign units to babies. Some hospitals do not give only fresh (less than 5 or 10 days old) aliquots either. Again, no requirement that only fresh units should be given to babies. Our hospital wasted many aliquots when we assigned only one baby to one unit. We changed our policy and now waste very few. We will use the unit until outdate. We also use only group O units for all of our babies.

[Liz]

if the patients blood was washed out ( massive transfusion ) like infusion of 10 - 15 units of the same group then different group what will happen ?:confused:

Massive transfusion is a totally different scenario. There is a given order in which you give the blood units. And a way by which you revert to the same blood group. This must be done following the SOP under the strict supervision and approval of the Medical Director and attending physician. There is a good AABB ref available. The patient will quickly form antibodies and there must be continuous testing of these. Again, do not attempt this if it is not your field of expertise.

[John C. Staley]

The patient will quickly form antibodies and there must be continuous testing of these.

Liz are you referring to ABO antibodies or atypical antibodies? If atypical antibodies you might want to change "will quickly form" to "may form". Not everyone is capable of producing atypical antibodies. Just being nit picky.

[Liz]

The patient will quickly form antibodies and there must be continuous testing of these.

Liz are you referring to ABO antibodies or atypical antibodies? If atypical antibodies you might want to change "will quickly form" to "may form". Not everyone is capable of producing atypical antibodies. Just being nit picky.

I definitely meant ABO antibodies, I should have been more precise.

Thanks John.

Liz

[Mabel Adams]

We had a situation a few months back with a bad type O trauma on a day we were short of O already and our shipment was late. It made me look hard at our inventory and communication about changes to the transport schedule. I did a little mental exercise on what I think is a possible number of O patients, how fast they could bleed and how long till I could get replacement blood (we are 3+ hours from our supplier). I used that to determine our critical minimum stock of O blood that we never get below. I also insist that we check with our courier every day to make sure we know when we can expect him. I rounded up some transportation plans that would be disaster only--like having our medical air service fly to bring us more blood--and wrote it down in our disaster plan. I know that I NEVER again want to be having discussions about giving ABO incompatible blood or drawing donors! I even wrote down all the reasons why we don't want to do those things. I also got some information from some pathologists who said they would give mismatched blood in a desparate situation, but I don't want to have any part in that if I can help it. We are going to try to prevent this one, not fix it.

[rravkin@aol.com]

We had a situation a few months back with a bad type O trauma on a day we were short of O already and our shipment was late. It made me look hard at our inventory and communication about changes to the transport schedule. I did a little mental exercise on what I think is a possible number of O patients, how fast they could bleed and how long till I could get replacement blood (we are 3+ hours from our supplier). I used that to determine our critical minimum stock of O blood that we never get below. I also insist that we check with our courier every day to make sure we know when we can expect him. I rounded up some transportation plans that would be disaster only--like having our medical air service fly to bring us more blood--and wrote it down in our disaster plan. I know that I NEVER again want to be having discussions about giving ABO incompatible blood or drawing donors! I even wrote down all the reasons why we don't want to do those things. I also got some information from some pathologists who said they would give mismatched blood in a desparate situation, but I don't want to have any part in that if I can help it. We are going to try to prevent this one, not fix it.

Hey Mable,

Are there any other hospitals closer than 3 hours away that may be able to transport blood products in an emergency?

[Mabel Adams]

We have 3 small hospitals close enough--we pretty much cleaned out all of their O pos supplies--maybe 16 units. Even that can take close to 2 hours depending on where the transportation starts and which route they take and whether it is snowing. We can be rather isolated out West so we need to plan ahead even more than most. Oregon has a bigger area than the island of Great Britain with less than a tenth of the population--almost all of which is on the other side of the Cascade mountains from us.