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Group O transfusion reaction


yaya

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can group O red cells transfusion to group A patient cause hemolytic transfusion reaction ( residual plasma) , and if so:

-is there any case study i can read

-what to do regarding emergent transfusion

-neonate transfusion

thank you

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As far as I know, there has been no such study for many years, although you may find something in the older editions of Mollison.

 

Certainly, high titre anti-A in FFP and platelets from a group O donor has been implicated in haemolytic transfusion reactions in neonates, particularly those that are small for age (premature).

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All of our neonates receive group O irradiated, leuko-reduced red cells. They receive AB platelets and plasma. Have never had a problem.  Also many times sickle cell patients get group O, if necessary to match their phenotype (if they have an antibody). Also if there are short dated O's on the shelf anyone can get them.. I think your medical director needs to have a discussion with the physician who refuses to take what the Blood Bank gives and explain that the Blood Bank makes decisions based on availability and inventory control.  What would this doc do in an emergent situation where you are issuing uncrossmatched O units?

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I think the issue of residual plasma might date back from the ACD and CPD anticoagulant days (hopefully not the whole blood days) when you had to leave more plasma (and associated goodies for the RBCs) in the bag. I don't work in a blood center, but now using ADSOL etc don't they squeeze pretty much every drop of plasma out before adding the additive solution? Can't be a significant amount of antibody left in there.

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I think the issue of residual plasma might date back from the ACD and CPD anticoagulant days (hopefully not the whole blood days) when you had to leave more plasma (and associated goodies for the RBCs) in the bag. I don't work in a blood center, but now using ADSOL etc don't they squeeze pretty much every drop of plasma out before adding the additive solution? Can't be a significant amount of antibody left in there.

I agree with Dr Pepper.  This used to be an issue back in the day of non additive red cells.   I have not seen a problem since we use red cells with additives. 

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  • 2 weeks later...

I don't think we should forget that there are some countries less fortunate than countries in Europe or the States where transfusing whole blood is still the norm becuase facilities don't exist to separate safely. In this case, it would be a good idea to check for high-titre anti-A. But in your case, you were transfusing packed red cells (I presume in a modern developed facility) - so it really should not be a problem

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We use O Neg, irradiated, CMV neg, leukocyte-reduced packed cells that have been washed for our premie neonates and all babies in our NICU. This reduces citrate-toxicity, issues with increased K+ and any potential reaction caused by residual plasma.  Plasma containing products must ABO compatible ( we prefer to give type AB products but don't always have that available).  

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