Low Titer Group O Whole Blood

[tsanders0703]

Hello,

 

Is anyone out there using low titer group O Whole blood for patients?  We are on track to use it for trauma patients in the near future.  Any information you can share about your process would be extremely helpful. 

A couple questions I have right now:

Can you run Whole blood through a blood warmer/rapid infuser? Seems like a no-brainer since it will be used for trauma patients, but you don't run platelets through a blood warmer, and that's one of the pluses of Whole blood is that there are activated platelets present. 

How do you cross match Whole blood? I vaguely remember learning about Whole blood crossmatches in school, but we were told we would never use Whole blood in real life   do you XM the patient's plasma with the donor cells, the the donor plasma with the patient cells?  Since it will all be group O blood, wouldn't we expect the plasma to be incompatible with out of group RBCs, even I found it is low titer? Is there any benefit to the crossmatch if we know it will be incompatible, and we know low titer group O is safe for non-group O patients?

Can we expect discrepancies in the reverse blood type of non-group O patients if blood is collected after Whole blood has been given? How much Whole blood before we can expect a discrepancy?

Can you switch to type specific packed RBCs after giving Whole blood? I understand that  bleeding patient will be bleeding out the anti-A and Anti-B from the group O plasma, but what happens Hohenzollern the patient stops bleeding, still has Whole blood in circulation Andy then you give type specific blood that will be hanging out with those antibodies for the next few weeks/months? Should we expect hemolysis? 

What limits did you set on the use of Whole blood? Only for certain diagnoses (just trauma? What about other massive bleeding like GI bleed, ruptured/perforated AAAs, post partum hemorrhage?)? Only in certain areas of hospital (just in ED/OR)? Is there an age limit/range? Is there a weight/size range/limit (specifically is it ok for smaller people)? Not available for people with specific conditions (CHF)?

How did you educate medical/clinical staff? Any good resources you are willing to share?

Any issues encountered in Transfusion Services (BECS? Tech training/understanding? Things you wished you'd have known when you started using Whole blood or lessons learned along the way?)

What is the max number of low titer group O whole blood units you will give a patient? 

How much do you maintain in inventory? How much is used vs. wasted? 

If you are willing to share any processes or procedures, it would be greatly appreciated!  Thank you!

 

[JoyG]

We are also implementing this hopefully by February.  Give me a call and we will discuss your questions.  215-955-1134

[Eman]

Hi, I can only answer some of your questions: We have had a Trauma WB protocol in place for a while. Below are our use restrictions, we generally only have 2-6 of these products available, so most recipients do get switched to RBCs after the initial WB transfusion(s). These are not crossmatched, being for trauma situations only, and are in fact issued on back up and reconciled in the LIS afterwards. Since we limit it to two products until the patient is typed, and they wouldn't get a group O after an incompatibility is identified, I don't believe we've had any typing issues subsequent to the WB transfusion. Seems like mixed field could be a confounder though.

• Product Use:
o Limited to adult patients weighing 40 kg or more
o Untyped recipients will not receive more than two of these units.
o Women of child bearing age and individuals with unknown Rh type will receive Rh negative products.
o Adult males and women not of childbearing potential (55 years of age and older) will receive Rh positive products.

 

A lot of these products went unused at first, but use picked up in the 2nd year of the program (I think we're in year 3 now)

[MaryPDX]

We have been using WB for traumas for a few months.  Ours are low titer (from ARC) and we have set up our system to allow WB to be given to any type. Also, we are allowed to give type specific red cells afterward.  We can give any amount necessary while they are in Trauma/Massive Transfusion Protocol status.

We limit this to adults only. 

Males and Females 45 and > get O+

Females <45 get O= (they can be given Rh Pos with Pathologist approval)

These WB products are collected using a system from Terumo (allows leukoreduction, but spares platelets).  When the product has 7 days left to expire, we convert the WB into a packed RBC which can be given to almost anyone.