Switching blood types in trauma situations

[maybe]

My facility's current SOP is to transfuse O red cells and A FFP in trauma situations until we have all the testing completed (including the second ABO typing) and enough compatible products are available to switch. We've not had any problems with following this process in the past (our trauma surgeons are amazing!) and we've always had enough O red cells and A FFP. However, last month we had a horrific trauma case come through that just decimated our inventory (hundreds of units in <24 hours) and the patient was AB Neg. Between this one patient and an emergency bleeding TTP patient we used almost all the A and AB plasma in the surrounding areas.

What do you do in these situations when you can't provide type specific products? Giving a patient incompatible red cells is a huge red flag, even though I have heard of other hospitals having a protocol in extreme emergency situations. After 100-200 units does it really matter as long as the transfused combo of FFP and red cells are ABO compatible? I'm not particularly worried about running out of O red cells units (our blood supplier has a very healthy stock), but at what point do you flip plasma to whatever type you have available? And when do you flip back?

 

 

[butlermom]

It doesn’t appear that anyone answered this 4 years ago. I am at a level 2 trauma center, functioning as a level 1 in hopes of getting designated as such this summer. You’ve given me something to think about for sure. I do have a question about the second sample type prior to switching to type specific blood. We are about to implement this policy and I’m wondering, when and who draws your 2nd blood type sample? 

[carolyn swickard]

For us - it is our Phlebs as much as possible.  They draw as soon as the Blood Bank generates the order and notifies them.  Not particularly optimal for a real messy trauma probably.  We are a Level 3, trying for level 2.

[Sonya Martinez]

For the second ABO we use a specimen collected at a different time like a CBC but we won't use one collected at the same time as the type and screen.  It's rare for us to request a specific draw for this testing but it does happen.

We're a level 1 Trauma in a Children's Hospital but can take adults during disasters and pandemics (new one for me).  We just changed our emergency issue and MTP policies adding in liquid plasma to start the MTP and we gave our computer the ability to give Rh POS to Rh NEG RBC and plasma products to males (policy stated if >1 year old with prior approval from pathologist on call and transfusing physician).  We are only to use it in extreme situations where there's no other option.  But with the working in AABB Standard 1.4.2 regarding product inventory shortages, 5.15.2.1 policy for use of RH pos RBC containing components to Rh Neg recipients I felt we didn't really have a choice.  Luckily we have 1 primary blood supplier and a secondary contract for platelets and other products during emergent situations.