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Giving O Pos PRBC's to a male JohnDoe during a Massive Transfusion.


Christiane

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During an emergency transfusion,our Hospital policy has been to begin the first round of PRBC's with O Negative, and then to switch to type specific  (when the type is known) or otherwise give O Positive if the patient is a Male or a female not of child bearing age. 

Recently, due to shortage of O Neg, there has been a suggestion to initiate the first transfusion with O Positive and not bother with O Neg as long as the patient is a male (or female over 50). 

For those of you who already have adopted a similar policy, have you encountered any problems after the fact, with the patient being readmitted somewhere and showing an RH positive blood type when really that patient could be RH negative? Do you issue cards to inform the patient of the possible change in blood type, at least for a few weeks after the initial transfusion?

Any suggestions on how we should go about this?

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1 hour ago, Christiane said:

During an emergency transfusion,our Hospital policy has been to begin the first round of PRBC's with O Negative, and then to switch to type specific  (when the type is known) or otherwise give O Positive if the patient is a Male or a female not of child bearing age. 

Recently, due to shortage of O Neg, there has been a suggestion to initiate the first transfusion with O Positive and not bother with O Neg as long as the patient is a male (or female over 50). 

For those of you who already have adopted a similar policy, have you encountered any problems after the fact, with the patient being readmitted somewhere and showing an RH positive blood type when really that patient could be RH negative? Do you issue cards to inform the patient of the possible change in blood type, at least for a few weeks after the initial transfusion?

Any suggestions on how we should go about this?

Yes - don't worry about it!

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The blood type should appear mixed field if an Rh neg person receives Rh pos blood (the opposite is also true). If we've  never typed the patient before, we consider them Rh neg until the type can be verified (contacting hospitals where the patients been recently, etc). 

Our facility has used O Pos red cells for males and females >45 years of age for as long as I can remember. 

Our department doesn't issue patient cards, at least not that I've ever seen. 

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I know it's happened, but the number doesn't seem to be very high.  (I'm going strictly on memory and not actual numbers).

The problem with that is, most of these type of people tend to be traumas, not the chronically transfused people you see often.  Once they've been discharged, we may not see them again or it may be years later. 

It may sound crass, but for it to be a problem, they need to survive the event which is causing them to bleed to death.  Developing an antibody (ANY antibody) is the least of their problems.

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2 hours ago, SMILLER said:

OK, perhaps Christiane is more interested in how often these Rh neg patients start producing anti-D after a situation like this?  Any data on that?  

(Anything to get more than one line from Malcolm--retired people apparently are not as verbose otherwise!)

Scott

Sorry Scott, but I (the retired one) have a very early start tomorrow for a meeting, but I promise I will give my views, which are very close to MaryPDX, the day after tomorrow!  If I don't, please feel free to remind me!

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Thank you all for your feedbacks.  ...and please keep them coming.  I am listening. 

One question though...am I to understand that most of you are giving O POsitive to males and females (>45 let's say) as the first set of units to be transfused, without even bothering with O neg ?

 

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3 hours ago, Christiane said:

Thank you all for your feedbacks.  ...and please keep them coming.  I am listening. 

One question though...am I to understand that most of you are giving O POsitive to males and females (>45 let's say) as the first set of units to be transfused, without even bothering with O neg ?

 

Correct. This is our protocol. Females <45, or whose age can't be determined (or if the sex is unknown) start with O neg red cells. 

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11 hours ago, Christiane said:

Thank you all for your feedbacks.  ...and please keep them coming.  I am listening. 

One question though...am I to understand that most of you are giving O POsitive to males and females (>45 let's say) as the first set of units to be transfused, without even bothering with O neg ?

 

Absolutely. In a traumatic massive transfusion especially that first round of O negs is going to waste.

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On 18/02/2017 at 7:07 PM, Christiane said:

During an emergency transfusion,our Hospital policy has been to begin the first round of PRBC's with O Negative, and then to switch to type specific  (when the type is known) or otherwise give O Positive if the patient is a Male or a female not of child bearing age. 

Recently, due to shortage of O Neg, there has been a suggestion to initiate the first transfusion with O Positive and not bother with O Neg as long as the patient is a male (or female over 50). 

For those of you who already have adopted a similar policy, have you encountered any problems after the fact, with the patient being readmitted somewhere and showing an RH positive blood type when really that patient could be RH negative? Do you issue cards to inform the patient of the possible change in blood type, at least for a few weeks after the initial transfusion?

Any suggestions on how we should go about this?

Scott asked me to expand on my one liner above!

In the UK, much of what we do is "governed" by Guidelines issued by the British Society of Haematology (BSH).  For some time now, they have advised that group O, D Positive red cells be given, in an urgent situation to all males and to females over 50-years-old.  As far as I know, this has resulted in no clinically unfortunate sequalae, and, also as far as I know (and I am one of the people who writes these Guidelines) there is certainly no plans to reverse this decision.

I am equally unaware of any problems encountered where the patient has been readmitted to a different hospital and the transfused O Positive red cells causing any problems; indeed, there used to be problems the other way round, when we used to give D Negative blood to D Positive patients, who were then thought to be D Negative.  However, in most cases, these patients are either too ill to be moved to another hospital (don't forget, you would only give uncrossmatched blood in extremis) and, sadly, some of them do not ever get the chance to go to another hospital (remember also, that a huge percentage of patients who receive a transfusion of ANY kind are dead within six months (because of the underlying pathology, I hasten to add, not because of the transfusion!).

We do not issue any cards, apart to those patients who warrant an antibody card.

I hope that helps Scott, at least, even if it doesn't help you Christiane (that was tongue in cheek, in case anyone thinks I was being nasty to either of you)!!!!!!!!!!!!!!!!!!!!!!

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  • 1 month later...
On March 30, 2017 at 4:33 PM, anapryz said:

At what point in time would you switch to type specific? Does it matter how many units of O were transfused before you go to ABO specific? Do you then perform an coombs crossmatch?

For red cells, we switch to ABO specific once we've processed a T&S (and a confirmation type on a second sample when not type O). We do that as long as we can (don't want to waste O cells on a non O if I don't have to). 

If the patient is Rh neg, and we had been using Rh pos during the massive, we don't switch back to Rh neg until the massive situation is over. 

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I agree with MaryPDX.  We start with O pos for males and females over 50. Remember, 85% of them will turn out to be Rh pos. We don't switch to Rh neg for Rh neg patients who have already received Rh pos until the crisis is over; they might get Rh neg for a top-off the next day, say. We don't use type-specific uncrossmatched as a rule--too likely for someone to assume they don't need to check ID because it is uncrossmatched, in my book.  We need a blood type on second specimen to give anything other than O anyway and by then the units will be crossmatched.

There is too little plasma in modern RBC units to worry about switching back to type-specific.  No special crossmatch required.  We might on occasion phone the BB of the receiving hospital to give them a heads up that we have caused the patient to type strangely or that we found antibodies if we think it is information they would want to know.  If you do blood types in gel, the mixed field is so striking it gets people's attention more than in tube testing. We only recently got an instrument that runs gel so we do gel blood types on it.  Maybe we will get used to the mixed field reactions eventually.

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  • 4 months later...

I agree with all the above we have used O pos on all our massive transfusion patients and on any emergency release blood given to a male or female >50. We also use A FFP in any emergency release or massive transfusion patient. The only problems that we have run into as with any massive transfusion patient is how late we get the T/S and then the patient shows as an O pos and then after being in the hospital a while starts to show their true type. As far as antibodies, in an emergency situation there are risks, but death is what we are trying to prevent. We have not had very many patients that come back with antibodies and Anti-D isn't even usually the one made. More often than not it is a K or Duffy, possibly a Kidd.

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