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Cathy

O Pos vs O Neg red cells for emergencies

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Hello All,

I'm wondering how many of you use O Pos instead of O Neg for emergency release of red cells for male patients and women older than child-bearing age?  If you start with O Negs for males, how many will you give before switching to O Pos?   Both of my questions are referring to patients for whom you have not been able to get an ABORh done yet. 

Thanks in advance!

Cathy

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We start with O Negs but after 4 - 6 units, we would switch to O pos for those patients in question in order to have the remaining  O Negs on hand for women of childbearing age, should  one show up.  Note also that our nearby blood supplier can have more RBCs to us within about 45 minutes.  We are a level 2 trauma center.

Scott

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If we know the patient's history and they are Rh Neg we might start off with a couple of Rh Neg O's.  We switch them over pretty quickly if they are going to use more.   Otherwise - they get O Pos.  

Took people in and outside of the lab a little while to get comfortable with this policy, but now no one blinks.

sandra

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We start with O Pos, though I would have to say that if we had history and knew the patient was Rh Neg, we would probably give Rh neg unless/until it looked like mass transfusion.

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Thank you all for your responses.  We are working hard to reduce our utilization so this is all good information.  Thank you and Happy Holidays!

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We start with O neg (2u - no more than 4u) and hope we have a specimen before the 2u are in.  We then switch to type specific and hope it is not O neg.  We are under pressure to switch to O pos by one of the ER docs - may have to go that way in the next year or so as they gear up here to be a Level 4 trauma unit.  So far, most of the emergency releases stop transfusing with 2 units.

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We are Level 1 Trauma Center with approximately 15 Massive Transfusion activations per month.  We keep 6 O POS and 6 O NEG in our ER refrigerator with 4 Group A Liquid Plasma.

We started stocking O POS units last summer when our blood supplier was struggling to keep up with our O NEG need.  The majority of our traumas are male and about 80% Rh positive.  It has made a tremendous impact on our O NEG usage.  The biggest concern was the possibility of a mistake and grabbing O POS for female patient but (knock on wood) that has not happened yet.  We have segregated the units by placing O POS in a Blue plastic bin and O NEG in a Pink plastic bin - and on a separate shelf.  O POS units are wrapped in a paper stating "FOR MALES ONLY". 

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We used to start with O pos for males over the age of 18 and women past child bearing age, but we don't do that anymore. We have actually given quite a few patients (ironically the majority of them being male!) an anti-D. We went back to giving O neg to all trauma patients. If the patient gets to the point where they take up to 5 or 6 units, we then convert them to Rh positive, with pathologist consent (unless we have a type by that time, and then we give type specific).

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I avoid giving O Pos to male trauma patients because if we give them an anti-D and they manage to show up as a trauma patient in the future, they are at grave risk of a serious reaction.  I would note though that since I am in a pediatric institution, this is more likely to occur than in a general hospital.

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If I am not mistaken, for a massive transfusion, a D neg patient who receives D pos blood is unlikely to develop an anti-D, (but I appreciate the concern!).  In any case, each facility has to decide how it will reserve O neg units for those trauma  patients that must have them.

Scott

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I would rather deal with the unlikely event that my male trauma patient develops anti-D, then presents again as a trauma, than deal with having to give a young Rh negative woman Rh positive blood because I ran out of Rh negative units transfusing an adult male or a 50+ year old female. My stock of O neg red cells is 8 with full stock and my blood supplier is 150 miles away. A trauma situation could very quickly deplete that supply.

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I avoid giving O Pos to male trauma patients because if we give them an anti-D and they manage to show up as a trauma patient in the future, they are at grave risk of a serious reaction.  I would note though that since I am in a pediatric institution, this is more likely to occur than in a general hospital.

 

Thankfully, we have never been faced with having to use O pos for a female patient.  There is usually not much delay in getting a sample;  we generally go to type specific pretty quickly.

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We give O POS to males and women over 55 yrs old.  We give O NEG to women 55.  That being said, if we have an ID before taking a cooler to ED and the patient is historically Rh NEG, we would start out with 4 O NEG and determine switching depending on gender, age and usage.

Brenda Hutson

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We are similar to Brenda, O pos for the men and women over 55.  I think any O neg inventory can be quickly depleted.  Having an OB hemorrhage case can easily go through 100 units.  Those women will get switched to pos pretty fast.  Our O neg inventory is about 150 units and that can still be a worry.  Yes, 1 patient will get switched before they deplete us, but what about 2?  3?  When it rains, it pours.

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53 minutes ago, Malcolm Needs said:

Jeez, that's a lot outside of a blood supplier.

We're a pretty big place.  We have an active labor unit, 50 or so ORs, level 1 trauma center, and support a huge cancer clinic.

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