Having a doctor when ever he requested for blood he insisted that same blood group should be giving to the patient even when the same group is not available in the fridge and when we  wanted to give O, D positive blood he always refuses. Please any advantages of giving same blood group to patient and the disadvantages of giving O, D positive unit to the patient 

Going to be grateful if you share your thoughts 🤔 🤔 🤔 

Neil Blumberg, I'll leave this one to you!

5 hours ago, Malcolm Needs said:

Neil Blumberg, I'll leave this one to you!

That was my 1st thought as well!

Maybe that doc is thinking of conserving the Os. 

Not like that 

Is this for emergency transfusion, or routine transfusions? 

Is this a transplant doc?

Not for emergency transfusion just routine transfusion and the doctor in question is not a transplant Doc. The patient was having severe malaria 

Perhaps this is one rare physician who actually reads the medical literature on the subject or has thought things through.

The history of this is very simple.  Based upon the experience of severe or fatal hemolytic transfusion reactions to whole blood, it was discovered that when a patient's ABO type was unknown, and urgent transfusion was life saving, group O was the least likely to result in disaster.  When group O red cells became available during the middle of the last century, with modest amounts of plasma left, it was decided by the then experts that this could be used for non-urgent, routine transfusions of all patients. So-called universal donor O red cells.  The problem, with the 100% accuracy of hindsight, was that we had no evidence this is was good, much less optimal practice. But it was convenient. It meant blood banks didn't have to stock all 8 Rh and ABO types, so it was good for us in the transfusion service. It wasn't good for patients.

Why is that?  Well, there is residual incompatible plasma with anti-A and anti-B in all group O red cells that haven't been washed or thoroughly volume depleted. Well, you might ask, and all of us have assumed for decades, that a few dozen milliliters of incompatible plasma is not a big deal.   The answer, now known to some extent, is that it is a big deal for some patients who are groups A, AB and probably B.  This small residual plasma can on rare occasions cause severe hemolysis.  It's 100% severe if it happens to you as a patient.  This has been known for decades. What is new is the data that recipients of ABO mismatched red cells (Group O in general) have a higher rate of red cell alloimmunization to other red cell antigens, (Transfusion 2012 Mar;52(3):635-40. doi: 10.1111/j.1537-2995.2011.03329.x; 2025 Mar;65(3):588-603. doi: 10.1111/trf.18135. higher rates of febrile and allergic reactions, (Transfusion 2012 Mar;52(3):635-40.doi: 10.1111/j.1537-2995.2011.03329.x.) higher rates of HLA alloimmunization, and perhaps overall higher rates of mortality (Transfusion. 2016 Mar;56(3):550-7.doi: 10.1111/trf.13376).

So, if you are a recipient, you want ABO identical transfusions, or compatible red cells that have had all or almost all of the plasma removed, as by washing, for example.

 

 

 

Edited May 5May 5 by Neil Blumberg

If you need copies of these reprints or have further questions, happy to help.  

Perhaps the physician is worried about residual plasma in the packed red blood cells causing hemolysis?   This used to be a problem decades ago when BBs were using CPDA1 units and many units were transfused.   I have not seen this issue since using ACD units.  Or what Dr. Blumberg said.  

 

Edited May 5May 5 by BBMT

Thank you very much Neil.

Thanks very much Dr Neil, perfectly understood your point, am where we mostly carried out whole blood transfusion over packed red blood cells transfusion and I perfectly understood your points while the mismatched is not good. Am just going to practice to give out same blood group. 

Looking at whole blood transfusion and PRBC transfusion which good? Not looking onto the points you listed above. Like a recipient blood group A and donor blood group A , 

Whole blood only makes sense for patients with life threatening bleeding. Red cells are safer for patients who have major anemia/minor and/or slow bleeding.  Whole blood will put many patients who are not hypovolemic into cardiac failure/pulmonary edema, and are, in general more toxic than red cells alone.

Thanks very much Dr Neil

In my long experience of using O Group CPD-SAGAM PRBC, we found no evidence of ALLOIMMMUNIZATION as long as Rh is the same. As the SAGAM replaces almost all plasma.

Okay thanks. Please the alloimmunization is caused by red cells antigens that's not found in the recipient blood but found in the donor cells or is due to the anti-A and anti-B antibodies in the plasma of the donor? 

When you have incompatible antigen or antibody, low level hemolysis occurs, probably with complement activation. This is not at levels clinically evident, but inflammation occurs. Inflammation potentiates (increases) B cell activation and provides one mechanism by which ABO non-identical red cell transfusion (without washing) increases rbc alloimmunization to other antigens being presented. It is known to the case, both from clinical observations (referenced in my previous post) and from animal models which provide evidence that the presence of inflammation increases alloimmunization to red cells and other antigens.  It's the mechanism by which adjuvants in vaccines increase immunization to microbial antigens in vaccines, by the way.  Inflammation.  Not a good thing if you are not infected and receiving transfused antigen :).  But useful if you are trying to get a beneficial immune response to an antigen.

Edited May 6May 6 by Neil Blumberg