B+ donor to O+ patient

[rravkin@aol.com]

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.

Mable,

When I read your post it reminds me of an article I read in Transfusion Mag. some time ago where the US Army did a study of the use of FFP for initial treatment of battle field trauma and showed a better prognosis for patients who recieved FFP first as opposed to recieveing PRBC's first. Given how remote your facility is I wonder what your use of FFP is for trauma patients and if the practice mentioned might be better for your patient given your limitted RBC inventory.

[Mabel Adams]

We aim for a 1 to 1 ratio of RBCs to FFP in traumas and usually come pretty close. This guy had gone through close to 20 units FFP and 20-some RBCs plus plts and cryo. We got anxious because my techs were looking ahead beyond the next hour or two in case he didn't slow down after finding out our blood shipment would be 3 hrs late. That's when we would have been in real trouble. Or if the 2nd O pos trauma that night had kept using blood beyond the first 2 or if the 3rd trauma had been more of a blood bank patient rather than just head injuries and had not been shipped out and not A pos. I took this as a learning case to make sure we knew our lower limits so we never would be in any worse trouble if the additional bad things had happened. We usually stock about 50 O pos and 20+ O neg so, as long as we don't let ourselves get too low, we can take care of most of our traumas. This day we started out with only about 30 O pos, so didn't have the usual cushion of safety.

[JOANBALONE]

Hi BBTers

Found this when surfing: http://www.cbbsweb.org/enf/2003/urgenttxaboincompat.html

JB

[conwaysbb]

Not to cause anyone to have a stroke, however, there have been some transfusions of what we would normally consider ABO incompatible transfusions via intrauterine transfusions. I believe the specific article I saw was an A Negative washed red cell transfusion from a mother with anti-D and other multiple antibody specificities to her baby that was O Positive and severely affected with HDN. This was done several times during the pregnancy and the baby was finally delivered with a blood type of A Negative who subsequently reverted back to O Postive

[dcubed]

Not to cause anyone to have a stroke, however, there have been some transfusions of what we would normally consider ABO incompatible transfusions via intrauterine transfusions. I believe the specific article I saw was an A Negative washed red cell transfusion from a mother with anti-D and other multiple antibody specificities to her baby that was O Positive and severely affected with HDN. This was done several times during the pregnancy and the baby was finally delivered with a blood type of A Negative who subsequently reverted back to O Postive

I'm thinking that you can get away with this because the baby is not yet immunocompetent. By the time the baby is ready to start making ABO antibodies the cells given during intra uterine transfusion will have, for the most part "died of old age".

[pdameron]

Not to cause anyone to have a stroke, however, there have been some transfusions of what we would normally consider ABO incompatible transfusions via intrauterine transfusions. I believe the specific article I saw was an A Negative washed red cell transfusion from a mother with anti-D and other multiple antibody specificities to her baby that was O Positive and severely affected with HDN. This was done several times during the pregnancy and the baby was finally delivered with a blood type of A Negative who subsequently reverted back to O Postive

Years ago my facility supported a woman with intrauterine transfusions through several pregnancies. I don't remember all the antibodies she had but they included anti-D, anti-C, anti-Dombrock B among others. The last 2 pregnancies we used short-draw autologous AB Neg units for the intrauterine transfusions since they were more compatible than anything we could find in the donor pool. About this time I formulated the brilliant idea that the blood bank should provide pre-marital antigen typings to assure that couples were truly compatible before getting married and making babies together.

[Malcolm Needs ☆]

About this time I formulated the brilliant idea that the blood bank should provide pre-marital antigen typings to assure that couples were truly compatible before getting married and making babies together.

Not entirely sure about this one!

I'm group A, R1R1 and my wife is group O, rr - so two chances of HDN (ABO and Rh), but after more than a decade of marriage, I still think that we are entirely compatible, although, of course, my wife Dee may think otherwise on the quiet!!!!!!!!!!!!!!!!!!!!!!!

:haha::haha::haha:

[BrianD]

I formulated the brilliant idea that the blood bank should provide pre-marital antigen typings to assure that couples were truly compatible before getting married and making babies together.

lol, i'd support this.......i'd love to finish my years of practice without ever dealing with anti-Kell HDFN ever again. i'd also encourage OB/Gyn clinics to get educated about anti Lu(a) and to stop scaring the crap out of expectant mothers with it.

[AMcCord]

Antibodies and pregnant ladies just ruin my day. :raincloud My students always suggest that 'they' (whoever 'they' is) should just make something like RhoGAM for everything else! Wouldn't that be handy:p.

[kate murphy]

Mabel, have you thought of having a supply of frozen O's for routine transfusions? That may let you manage your liquid inventory easier in times of shortages. I'm in Boston, very busy truama center - we get all of our blood flown in through the National Blood Exchange (local supplier too $$$) and we've got several large hospitals around to share with when necessary. I usually keep 80 O Pos, 60 as a minimum. But I still have 50-75 frozen O's for routine transfusions when inventory seasonally dips. Tends to even things out for us.