I am interested in your policies for switching a patient back to his own blood group (i.e. Group A) after receiving Group O units. How soon do you switch back, after how many Group O units, what patient testing do you do?

Packed RBCs have negligible plasma on them. A nearby hospital switches patients back regardless of how many Group O units they have received.

Mary

I have always just switched them back to their own type as soon as the immediate emergency need for O's was over. I've always had a dedicated BB staff who was comfortable with doing this; in other instances, rotating staff may be more comfortable keeping the patient on O until their forward type starts "showing" again, but I always thought this was a waste of Os.

MJD:D

Thank you.

We always switch back ASAP after the emergent situation

I'm with MaryJo and David. We switch back as soon as we can. That is usually once we get a sample and a blood type on the patient.

The other side of this coin is how soon do you switch back from Rh positive to Rh negative in an Rh neg patient? This is the one that has always bothered me. Usually we switch due to Rh negs being in short supply and switch them back once the current episode is over but I don't have a good answer when asked. Anyone else have any ideas on this part of it.

Does it matter how many units the patient has received?

I am interested in your policies for switching a patient back to his own blood group (i.e. Group A) after receiving Group O units. How soon do you switch back, after how many Group O units, what patient testing do you do?

Packed RBCs have negligible plasma on them. A nearby hospital switches patients back regardless of how many Group O units they have received.

Mary

We are Level 1 trauma center and our policy for massive transfusion protocol states that, release O Positive unxm rbc for male patient. When specimen is received and if patient is Rh negative, we continue giving Rh positive xm or unxm rbc until rapid transfusion continues, eg. operating room but switch to Rh negative when patient is more stable and usage is lesser in ICU. For ABO, as soon as blood group is available we switch to patient ABO.

There used to be a thought that you could switch back to the original type from O as long as the patient still reverse typed as his own type. No one ever made real clear whether one should take the reverse through AHG looking for those high-titer O donors but with the small volume of plasma on Adsol units, I would think it would not be necessary.

One other thought: if you have a situation where chaos reigns (maybe multiple traumas all with the same last name), keeping on with the Os just due to the risk of mistransfusion is worth a thought. John Staley made me think of this once with regard to units shipped in helicopters with patients. The flight crew was going to assume the units in the cooler/box were for their patient--but what if someone handed them the wrong cooler with type-specific blood (for someone else) in it.

We switch back ASAP, usually after only 1-2 units are given. It only takes 30 seconds to do a forward ABO before you even spin the specimen. There is a critical shortage of O neg and A neg blood in Florida at the moment, so we try are hardest to hold onto our O negs.

Gil

1- As soon as patient's plasma is clear of irregular Iso-agglutinin(s),in this case irregular Anti-A Iso-agglutinin.

2- The test that needs to be done perior to this switch-back is testing for Anti-A Iso-agglutinin at the AHG phase.

Only when this is negative would switch-back be entertained .

Therefore,switch-back is NOT necessarily time dependant.

I wonder if there have been any studies done, or if these policies are just what made someone feel better about it.

That is NOT true iam afraid,it's there in AABB Standard Manual.

This Anti-A or Anti-B is aquired phenomena,(from the group O units given) it can either be IgG or IgM,if IgG i think it can stay upto 3 weeks and IgM little longer.

That is NOT true iam afraid,it's there in AABB Standard Manual.

This Anti-A or Anti-B is aquired phenomena,(from the group O units given) it can either be IgG or IgM,if IgG i think it can stay upto 3 weeks and IgM little longer.

Am I right in thinking that you are transfusing mainly whole blood rather than red cell concentrates. I know there are still some parts of the world where this is still the norm. Obviously, the situation is not going to be the same if you are transfusing whole blood or rede cell concentrates, as the latter have very little plasma available. It will also make a difference depending on whether the donor plasma is tested for high-titre anti-A/anti-B or not

What about in neonate Transfusion?

We never use whole blood in our Blood Bank.

I am very proud to say that KAMC- Transfusion Medicine Dep't.is Accredited by both AABB and CAP.

The very little plasma may mean alot for a small child.

We never use whole blood in our Blood Bank.

I am very proud to say that KAMC- Transfusion Medicine Dep't.is Accredited by both AABB and CAP

So.... if the patient is an A and you continue to give O then you keep adding to the anti-A and anti-A,B load which continues to attack the patients cells. You are just continuing to feed a vicious cycle.

I'm afraid that this is one discussion where the logic of giving a baby who has mom's anti-A in them, type O cells containing more anti-A has complete escaped me. I simply can not follow the logic of pouring more gasoline on the fire you are trying to put out.

Hi John,

I note with interest your trepidations over our use of group O red cells in neonatal transfusion setting; your major concern being that it would elicit a "vicious circle" of hemolysis in e.g. group A neonate with maternally acquired anti-A.

Theoretically, your concern would appear to have merit. However in our experience, this is not the case for the following reasons:

1. The group O red cells used are virtually completely depleted of plasma and hence virtually lacks anti-A,B.

2. Any group O cells from donor with high titre isoagglutinins (hemolysins) are excluded for such use except washed and reconstituted in AB plasma.

3. The group O cells are used only for top-up (small volume (< 50 ml) transfusions).

It's not just you, this is a standard of practice at most places including my own that I personally have issues with but have been unable to get much attention for. The numbers are small and no one seems concerned. It's just an argument in logic I like to raise every chance I get. It makes people think and that is a good thing.

In my previous employment in a level 1 trauma center, we switched blood types ASAP in adults with no ill consequences ever noted. As Abdulhameed noted, there is so little plasma in our packed cells these days that whatever anti-A,B is there is just insignificant, regardless of the number of units given to an adult. We transfused about 20 pedi units a day in our neonatal and pediatric ICUs, and we always used O cells with no ill consequences. However, within the last year or so, a less-experienced tech swapped to type-specific in a patient with HDFN, without crossmatching to AHG, and the maternal anti-A,B was still high, with disasterous consequences. The baby lived, but it was touch and go for many days.

On a side note, I have joined Ex-Bloodbankers Anonymous. It has been 136 days since my last crossmatch . . . .

BC

Workin' on the railroad

Bob, can you remember how strong of the ABO HDFN baby's DAT?

The DAT was 2-3+, and the plasma was dark brown from all the hemolysis.

BC

Bob, what was the DAT before the transfusion?

And what antibody caused the HDFN?

The DAT was moderately high, with the maternal antibody titers through the roof- in the 10,000 area. There were multiple intrauterine transfusions and a couple of exchange transfusions upon early delivery. Mom had anti-D,-C (not G) and -K. Baby had all antigens. Erythropoiesis was apparently depressed by the anti-K to boot.

BC

How did the baby have enough maternal anti-A,B to react with the transfused cells, but not have ABO HDFN?