Last night I had an ER physician insist on O negative RBC to give uncrossmatched to a 59yo male. Even though my tech explained our protocol for O pos, he still insisted on O neg. For the patient's sake, she released the O negs(what a pity, the patient turned out to be O pos). Can someone please give me a reference that discusses emergency transfusions using O pos for males? I have reviewed an article from Transfusion vol 43, issue 7 that was mentioned in another thread. Thanks for the help.

:disbelief:disbelief:disbelief

I don't know whether this will help you, because it is in a BCSH Guideline designed for use in the UK, but it is mentioned in "Guidelines for compatibility procedures in blood transfusion laboratories.".

This can be found under References (at the top of this page), Document Library, United Kingdom, BCSH Guidelines.

As I say, it probably won't help, but you never know. After all, 60-year-old males are 60-year-old males, wherever they may be in the world!

if we dont know the Rh of the pt then best choice is o neg if we have available .if you dont have then o pos age of the pt will be considered later

I think you need to get your medical director involved. Have your doc talk to ER doc. I assume you have a policy in writing that you can share with the ER doc? or for that matter all physicians in your hospital. THe other day we had an ER doc demand Rh positive blood for an old, Rh negative female patient. Yes, he knew she was Rh negative. He just did not want us wasting precious Rh negative blood on an Rh positive patient. Sometimes I wish they would just let us do our job.

JB

Sometimes I wish they would just let us do our job.

JB

Why only "sometimes" Joan????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:confused::confused:

If a patient only needs 1 or 2 units of uncrossmatched blood, we would probably try to give him O neg if we had enough. If it looks at the outset that it is going to be a massive bleed, we put him right into O pos.

oops, I just reread my post. I should not post after a long night at work. What I meant to write was he did not want us wasting precious Rh negative blood on his Rh negative patient.

JB

We just switched our "Code red" protocol to release Oneg or O pos depending on the rh..before we were giving type specific uncrossed if needed by doing a quick front type but I guess that was against AABB recomendations. So now once we have a complete type (front and back) we switch types if needed. We also do not have anything documented about giving Rh pos to Rh neg when appropriate. It would be nice to have some more wiggle room on certain occasions though.

As it is a deviation from your written policy/procedure, you could have asked them to sign for it. Whenever you ask an MD to sign for blood, we have discovered, they tend to think twice & usually go with what we tell them. That or we can sick our pathologist on them.

That or we can sick our pathologist on them.

Should this not have been in the "Just For Fun" thread!!!!!!!!!!!!!!????????

Sorry, couldn't resist it!

:D:D:D:D

No problem!

For emergency release, we give O Pos to all males, O Neg to females under 50. Though if a massive transfusion is called, then we switch to O Pos.

I agree with Joan - have your medical director get involved and a formal policy written.

Thanks everyone,

However, my original question was regarding references that my manager wants us to have as ammunition. Know of any?

By the way, my most tenacious tech was working that night and did her best to follow protocol and use O pos. We are now on emergency level of O neg in our region and I sure would like to have the 2 O negs back that we gave. My approval is needed to release any O neg for transfusion.

:juggle::juggle::juggle:

Thanks everyone,

However, my original question was regarding references that my manager wants us to have as ammunition. Know of any?

By the way, my most tenacious tech was working that night and did her best to follow protocol and use O pos. We are now on emergency level of O neg in our region and I sure would like to have the 2 O negs back that we gave. My approval is needed to release any O neg for transfusion.

:juggle::juggle::juggle:

Sorry KKidd, I only know of the BSCH Guidelines, and like I said, I'm not sure that anyone outside the UK would take any notice of them (some in the UK don't either - but that's another story)!

:redface::redface:

Last night I had an ER physician insist on O negative RBC to give uncrossmatched to a 59yo male. Even though my tech explained our protocol for O pos, he still insisted on O neg. For the patient's sake, she released the O negs(what a pity, the patient turned out to be O pos). Can someone please give me a reference that discusses emergency transfusions using O pos for males? I have reviewed an article from Transfusion vol 43, issue 7 that was mentioned in another thread. Thanks for the help.

:disbelief:disbelief:disbelief

Sorry...I can't quote specific references and page #'s and etc....What I can tell you is what happens at our hospital... Our BB Medical Director is very against switching from Pos to Neg--yep, even in a male!!! It is required protocol to contact the Path on call prior to such an event (if it is after-hours). We always hope for the non-BB Path to be on call because they will ask us what to do....

We recently contacted this BB Path about a massive transfusion protocol happening....the MAN had already used >11 units of O Negs. He told us to use our supply of O negs down to 2 left...then we could switch to O Pos. WHAT??? We typically keep 20 in stock...we are supposed to alert ER and Surgery if we get below 10 and they begin cancelling surgeries.

Need I mention the ARC told us point-blank they could not restock us...?

Thanks everyone,

However, my original question was regarding references that my manager wants us to have as ammunition. Know of any?

By the way, my most tenacious tech was working that night and did her best to follow protocol and use O pos. We are now on emergency level of O neg in our region and I sure would like to have the 2 O negs back that we gave. My approval is needed to release any O neg for transfusion.

To quote Dr. John Hess of Baltimore Shock Trauma (2nd article below), "trauma tends to be a guy thing."

A brief PubMed search yielded 2 articles on the topic. There may be more.

Surg Gynecol Obstet. 1988 Sep;167(3):229-33.

Use of Rh positive blood in emergency situations.

Schmidt PJ, Leparc GF, Samia CT.

Service Laboratories, Southwest Florida Blood Bank, Tampa.

The emergency blood needs of 449 patients were met by supplying 1,717 uncrossmatched units of either red blood cells (RBC) type specific Whole Blood or group O RBC. The RBC were all Rh positive, and 601 units were transfused to 262 untyped patients. None of the patients presented with anti-Rh antibodies. Only 20 patients who were Rh negative received group O Rh positive RBC, and most of these patients were male. There were no acute hemolytic reactions or sensitizations of young females. Group O Rh positive RBC is our first choice to support patients with trauma who cannot wait for type specific or crossmatched blood. Those who do survive the emergency conditions can be reverted to blood of their own type without problem. Acceptance of Rh positive emergency transfusions by physicians giving emergency care can prevent unbalanced shortages in a regional blood supply system.

J Trauma. 2005 Dec;59(6):1445-9.

Safety of uncrossmatched type-O red cells for resuscitation from hemorrhagic shock.

Dutton RP, Shih D, Edelman BB, Hess J, Scalea TM.

R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. rdutton@umaryland.edu

BACKGROUND: Uncrossmatched type-O packed red blood cells (UORBC) are recommended for immediate transfusion in hemorrhaging trauma patients. The potential for alloimmunization with this technique is controversial, and has been reported to be as high as 80%. We examined a 1-year experience with UORBC transfusion to determine the incidence of allergic reaction and alloimmunization. METHODS: Blood Bank and Trauma Registry databases for the year 2000 were linked to determine the incidence of UORBC use and the characteristics of patients, including the incidence of transfusion reactions and seroconversion of Rh-patients. Ten units of type-O, Rh+ blood (and two units of O-blood for women of childbearing age) were available for immediate transfusion, 30 to 45 minutes sooner than type-specific or crossmatched red blood cells. UORBC were administered to any patient with signs of severe hemorrhagic shock, at the discretion of the attending physician. RESULTS: In all, 480 trauma patients (out of 5,623 admitted) received transfusions of RBC, totaling 5,203 units. Five hundred eighty-one units of UORBC were given to 161 patients. Average Injury Severity Score in the UORBC cohort was 33.8. Patients receiving UORBC received an average of 16.9 total units of red blood cells, 14 units of plasma, and 10 units of platelets. Seventy-three patients died (45%). There were no acute hemolytic transfusion reactions observed in the patients who received UORBC. Four Rh-women received UORBC, all O-. Ten Rh-men received O+ blood, and only one developed antibodies to the Rh antigen. CONCLUSION: The need for UORBC is associated with significant injury and the need for subsequent massive transfusion. In this largest reported trauma series, the use of UORBC enabled rapid administration of red cells to hemorrhaging patients, without discernible risk for transfusion-related complications. The rate of seroconversion of Rh-patients is lower than reported in the literature, perhaps due to immune suppression associated with hemorrhagic shock.

Edited December 8, 200915 yr by bbbiker

We will start with O neg, unless we have multiple victims. We switch to Opos after 4 O negs and no specimen, or very high use, or the doc declares this a 'massive transfusion.'

bbbiker gave some really excellent references. I have some others at work and will try to locate them tomorrow.

(Though they won't be better than these).

Typically, as you all know, in a "massive transfusion" situation the blood is going in and then out again too fast for a person to be immunized against anything. I totally understand the hesitancy to switch a female of child bearing age to Pos...but a male? Come on!! What is wrong with our BB medical director???

Yes,Doctors only receive 1 hour of bloodbank training and signing an emergency release form with a little knowledge is unsettling for them,have your path enlighten them on protocol and product availability.Education is the key,don't give up.

o neg blood can be given to o pos patients irregardless of their age in cases where there is no available o pos blood.

Yes,Doctors only receive 1 hour of bloodbank training and signing an emergency release form with a little knowledge is unsettling for them,have your path enlighten them on protocol and product availability.Education is the key,don't give up.

Unfortunately it is the Path who is not on board with switching! See previous post about "Use our O neg inventory down to 2 units, then switch".

In the emergency room we issue O positive to male patients and O negatvie to female patients. If the need arises during surgery we give only O negative no matter what the patient sex is. We do not require the OR staff to let us know when they are comiing just to bring the patient's two identifiers and we give them pre-set up coolers of blood.

This is our protocol.

Why do you have different protocols for ED and OR?

This has been in place prior to me being employed at this facility. We have more time in our ER to decide which type to give, when the nursing staff come to our staellite blood bank which is located right out or surgery we give them a cooler of blood that is only O negative. We do not want to delay treatment in any fashion.

o neg blood can be given to o pos patients irregardless of their age in cases where there is no available o pos blood.

That happens a lot where you're from? Where there are more O neg units on stock than O pos? I would like to work where you work

Edited December 26, 200915 yr by trisram