Issuing type-specific blood in an emergent situation based on patient's historical record

[tupton]

Hello all,

Does anyone have any thoughts/comments about the practice of issuing type-specific blood to a patient (trauma) that has a historical record?

For example, patient John Smith presents to the ED with a stab wound. His identity has been verified and is registered in our LIS and has the proper ID band on. Mr Smith has been seen before at our facility, having received 2 units of blood 2 years ago and is type A pos. The physician orders a T&S because the stab wound seems to be superficial.

All of the sudden, the patient begins to bleed out and the ED asks for uncrossmatched, Emergency Release units. Mr. Smith is an A pos.

Do you issue type-specific, uncrossed A pos based on the historical record or O neg until a blood sample can be obtained?

Thanks for the help!

Tom

[goodchild]

Since it's a John Smith we would provide emergency released O Positive units. Could be misregistered, the original registration could have been a shared ID card, you really never know.

[swede]

We would definitely stay with type O until a specimen is received. Never ever go with an historical record.

[LCoronado]

We would definitely stay with type O until a specimen is received. Never ever go with an historical record.

Same here!

[DFields]

Echo that, never rely on past history, must recheck a current sample!

[KKidd]

My one word answer is never. We had a patient who came into our facility and was typed as O pos. When the "same person" was admitted to our sister hospital he had a different ABO type. It was finally decided that someone else used that person's ID. I won't even give plasma without a type on the current admission.

[tupton]

Thanks so much for the replies!

[David Saikin]

Never release rbcs on historical blood type.

[Dr. Pepper]

I agree with the other posters; we have seen many cases of people using someone else's ID or incorrect registrations. Never!

[Mabel Adams]

We have a family with a set of young adult twin males and a father in town that all have the same exact name! Dad is II, one twin is III and the other is IV. We could have two people with the same name and DOB (that may not be identical twins) and they would have different blood types! And they could easily be in the same car wreck. Besides, in the fast-paced excitement of the ED, ID mistakes may be more likely and there is less time between steps to catch problems and mistakes. I really dislike uncrossmatched type-specific blood because I worry that someone will see the uncrossmatched sticker, assume it is universal donor blood and give it to a different emergency patient without doing a good ID check--after all, it's uncrossmatched, it must be O. Stick with O until you have a type AND can be sure that people are doing thorough ID checks.

[Eagle Eye]

same her. We never use historical type to issue any products. We give type O until patient's type is confirmed from current specimen. We go little farther........if we need to give out any component before the completion of type and screen, we do tube method type by two techs from same specimen before releasing type specific component.

[Liz]

NEVER!!!!

O negative RBCs ONLY, no choice, no thoughts, no nothing.

[EDibble]

OMG, never!

:;shudder::

[David Saikin]

At least group O Liz . . . we only give the negs to females of child bearing age . . .

NEVER!!!!

O negative RBCs ONLY, no choice, no thoughts, no nothing.

[profbaud]

We issue O Negative if its a woman <55 years old or O Positive if a man or woman > 55 years old regardless of historical blood type unless the patient has Anti-D. my policy states that type specific blood can only be issued if a current blood type has been performed on a banded blood bank specimen and a 2nd blood type [historical or 2nd draw] has been done. If only one blood type is available on current specimen, the O Positive is given or O Negative. I have been at other facilities where immigrants get one insurance card and pass it around to relatives who go to the ER. one time a patient changed blood types, from O+ to A+. /We later found out is was not the same patient, so I do not recommend using historical blood types.

Debbie Baudler MS, MT(ASCP)SBB

[Liz]

yes i stand corrected.

[Liz]

i keep O negs for emergencies so thats what I send out. No time for gender and age. Disasters!!!!

[Changezi]

We would definitely stay with type O until a specimen is received. Never ever go with an historical record.

having same policy here as i am working in trauma center.