I apologize if this topic has already been asked, I searched and couldn't find it! 

I have a trauma helicopter that wants to start carrying red cells (United States).  I am concerned about the possible regulatory issues surrounding this process.  We discussed most of my concerns.  However, when I asked about a patient specimen for crossmatching I was informed that no there hospitals that provides this service has ever requested a sample.  I was always under the impression we had to perform crossmatches on blood we release in emergency situations, I consulted my medical director and he was on the same page.  There is always the possibility that I am reading too much into the FDA CFR/AABB Standards and perhaps there is a more flexible interpretation.  Would someone please let me know if you see this differently?

First, blood given pre-hospital is quite routine these days. Both ambulances and helicopters are carrying Low Titer O Positive whole blood that they transfuse on scene in response to traumas and hemorrhagic shock. In South Texas, the ambulances and helicopters receive their blood directly from our blood supplier. Who will be stocking your helicopter? Will it be your facility? If so, you have a lot of work to do. If your supplier, you have nothing to fear.

Second, when a unit is given pre-hospital, our EMS techs give the empty blood bag and a record of transfusion to the receiving nurse in the Emergency room, who then sends them to the blood bank (theoretically, practically we seldom get them right away). Our emergency room physician orders a type and screen upon arrival. Only if an antibody is detected (or we have a history of a clinically significant antibody) will we perform any crossmatching with the unit. 

I would suggest you google the topic Low Titer Whole Blood. It will help you answer your question.

If the patient's antibody screen is negative, you won't be needing a segment from the blood on the helicopter.  You can perhaps do an electronic crossmatch in those cases.  We do the crossmatch retroactively when we receive the patient's sample. 

But like what Jay said, if the screen is positive or the patient has a history of Ab's, you will need a sample of that transfused donor blood to do an AHG crossmatch, antigen typing, etc... 

Do you know who will provide the blood for the helicopter? Our blood provider is also a transfusion servicer/IRL, so they saves samples of all units provided.  They can send us a sample of the donor blood so we can do our crossmatch.  In the case of the patient having an antibody/Ab history, we do the crossmatch retroactively after we get a patient's specimen and a sample of the donor's blood.  Good luck.

 

Edited February 12, 20232 yr by SbbPerson
in hopes for better clarity. sorry my english is bad

We have an active pre-hospital emergency service with both ground and air transport that carry blood products. If the patient doesn't come to a facility within our system, we don't have a specimen or even a system-generated ID, so the blood is issued in our LIS with a comment describing what happened in case of collection facility lookback.

An alternate scenario is where the patient expires prior to specimen collection - if you don't have the specimen, you can't test it and we document that the units were issued emergency release and cancel the system generated crossmatch with a comment that no specimen was received.

We do the crossmatches if we have a sample, but there are times as applejw points out when we get no sample, so we document and move on.  We supply our helicopters so keep segments from the units which we can use for serological crossmatches if needed.  Mostly, we do electronic.