13 hours ago, Neil Blumberg said:

Transfusion has much more serious adverse effects than making an anti-D.  Increases in infection, sepsis, thrombosis, inflammation and mortality for example. 

There are no data to my knowledge of long term effects of anti-D formation in patients not having future pregnancies.  Most such patients come to the attention of the transfusion service because they have anti-D or simply because they are Rh (D) negative. They are then transfused with D negative blood if need be, in something like 99.99% of cases.  The rare patient who gets Rh positive blood (trauma patients) do sometimes have increases in bilirubin, LDH, etc. and delayed or rarely acute transfusion reactions. These are bad for patients, so you are right, for these rare patients, the outcomes can be dire.  But there few alternatives to transfusing Rh (D) positive blood to most patients in emergencies.  And very few will have future transfusion reactions.

I am new here, I was not getting the discussion. 

You explained very well, thank you.

I'm paraphrasing quite a bit but I was one time told by a blood banker I highly respected; "Get the ABO right first and foremost, then take care of the rest the best you can!" 

Another favorite of mine comes from an ER Physician, probably the best I ever worked with.  "Halitosis is better than no tosis!"  I'm sure that applies similarly to a severely bleeding patient. 

One of my own favourites is from Dr Brian McClelland MB ChB ND Linden FRCP(E) FRCPath, Consultant Haematologist, Scottish National Blood Transfusion Service, Edinburgh, UK, who said,

"Transfusion has risks, but bleeding to death is fatal."

I believe it was also him (although I could be wrong here) who said something along the lines of, "Giving perfectly compatible blood to a corpse is not a medical triumph!".

Just to give credit where credit is due.  

“Obtaining compatible blood for a corpse is not a therapeutic triumph.”  Ed Snyder, MD (Yale University) ISBTS meeting (Edinburgh) September 6, 2002

All bleeding stops.

I believe everyone responding and the AABB (if automatically, regardless of inventory, giving oPos to every non baby maker in every emergency request) missed the point of my concern. 
 

I have been a BBanker for 37 years. Lead tech for 10. Supervisor for 5. In large trauma hospitals and small community hospitals.  I do question what I think is wrong or tunnel thinking. At work. At home. And here. 
 

These replies equate questioning with wanting or ignoring the life of the patient.  That’s BS and never what I implied except in peoples minds. 
 

In the past, before what appears to be current universal policy, in emergencies our policies and our minds in an emergency went to balancing an unknown patients needs with inventory. Which this new policy is really all about: INVENTORY. 
 

My problem is no room in policy for considering inventory.  In the past we all (I think. I know each of the 7 hospitals I worked) all had policies on when to switch to OPos in emergency. Ie:  bleeding out patient. Low inventory of rh neg. 
 

That is not THIS.  Automatic give Opos. Even if you have 3-4 times your minimum inventory of rh neg units. 

So what happened?  Was there a believe that Anti D is NOT a risk to a patient in acute or later (getting more Opos in another emergency when one has Anti D) ?   Was this believe based on stories other than extreme hemorrhage?  Every study I read (and yes I investigated) discusses unstable hemolytic state why they don’t make antibodies. Ok I accept that.  At what point is a person unstable?  Loosing 1-2 units of blood. Or 1/2-full orig blood volume in their body?   The massive was designed by the army. For blown off arms and traumatic injuries where all clotting and body fluid is a mess. The policy works very well for that.
 

BUT that is NOT what I’m talking about. I’m talking about a dr only wanting to give 1-2 units of blood and that’s it. Patient is fixed.  Where are those studies?  Because no one I’ve heard says Anti D is non significant antibody (and yes don’t twist my words. I am not saying every patient will make anti D). But with routine not testing prior to giving blood in emergency:  the % of population with anti D WILL continue to grow with this policy. I’ve already seen it. So giving OPos with no regard to history or testing:  I think we just don’t see it yet in most practice. But that does not mean it will not become a problem. UNLESS Anti D is now considered clinically insignificant except for unborn babies.  Can you tell Me if THAT has been determined?  Because I haven’t read that in AABB technical manual at all. 

If it’s still considered clinically significant. Why are we ignoring it in our policy? Massive code is being used for straight emergency release (1-2 units). Someone posted all their emergency get OPOS. By that statement I am assuming 1-2 units only. No hemolytic state exists.  I am having trouble reconciling our concern that even with good inventory We ignore Rh status. 
 

There are other solutions to managing Oneg inventory than by ignoring Rh status altogether. Ie: Get type with tube or slide immediately. Even getting tube to blood bank in 5 minutes. That’s a forward type. No spinning required. Just test your emergency after firstvisduing 2 units oneg. Before they get rest of massive (4-6 units) you will have Rh type. But no.  NO other alternatives are being discussed or promoted. Makes me wonder why not? 

28 minutes ago, Mabel Adams said:

Just to give credit where credit is due.  

“Obtaining compatible blood for a corpse is not a therapeutic triumph.”  Ed Snyder, MD (Yale University) ISBTS meeting (Edinburgh) September 6, 2002

Thanks Mabel.  Quite right too.  Huge respect for Ed Snyder.  Met him when he was given an award by the BBTS, and also when we both lectured in Rhode Island.

Maybe some of these references are helpful. 

7. Selleng K, Jenichen G, Denker K, et al. Emergency transfusion of patients with unknown blood type with blood group O Rhesus D positive red blood cell concentrates: A prospective, single-centre, observational study. Lancet Haematol 2017;4:e218-24.

8. Frohn C, Dümbgen L, Brand JM, et al. Probability of anti-D development in D– patients receiving D+ RBCs. Transfusion 2003;43:893-8.

9. Gonzalez-Porras JR, Graciani IF, Perez-Simon JA, et al. Prospective evaluation of a transfusion policy of D+ red blood cells into D– patients. Transfusion 2008;48:1318-24.

10. Tchakarov A, Hobbs R, Bai Y. Transfusion of D+ red blood cells to D– individuals in trauma situations. Immunohematology 2014;30:149-52.

11. Yazer MH, Triulzi DJ. Detection of anti-D in D– recipients transfused with D+ red blood cells. Transfusion 2007;47:2197-201.

12. Burin des Roziers N, Ibanez C, Samuel D, et al. Rare and transient anti-D antibody response in D(–) liver transplant recipients transfused with D(+) red blood cells. Vox Sang 2016;111:107-10.

13. Yuan S, Davis R, Lu Q, et al. Low risk of alloimmunization to the D antigen in D– orthotopic liver transplant recipients receiving D+ RBCs perioperatively. Transfusion 2008;48:2653-5.

14. Schonewille H, Haak HL, van Zijl AM. Alloimmunization after blood transfusion in patients with hematologic and oncologic diseases. Transfusion 1999;39:763-71.

15. Goodell PP, Uhl L, Mohammed M, Powers AA. Risk of hemolytic transfusion reactions following emergency-release RBC transfusion. Am J Clin Pathol 2010;134:202-6.

From this: Association Bulletin #19-02 - Recommendations on the Use of Group O Red Blood Cells (Revised) (aabb.org)