Emergency uncrossmatched transfusion effect on blood type alloantibodies

Miraflor, Emily; Yeung, Louise; Strumwasser, Aaron; Liu, Terrence H.; Victorino, Gregory P.

doi:10.1097/ta.0b013e31823f0465

Cited by 25 publications

(20 citation statements)

References 18 publications

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“…This approach is supported by data from the US demonstrating that blood supply with non-cross-matched units of RBCs is safe in trauma patients [6,7,8,9,10,11,12]. Transfusion with RhD+ RBCs does not increase the rate of hemolytic transfusion reactions disproportionally [12].…”

Section: Introductionsupporting

confidence: 49%

“…Other studies [3,8,9,11] reported well lower exposure rates (6-7%), partially, because a limited number of RhD- units was also available in the ER [3,8,9]. The British Guidelines recommend to use no more than 2 units of RBCs for patients with unknown blood group [23] and to switch to RhD+ units in men, women of not childbearing age, and in MTPs, a recommendation that was implemented in many trauma centers [24].…”

Section: Discussionmentioning

confidence: 99%

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Unmatched Type O RhD+ Red Blood Cells in Multiple Injured Patients

Flommersfeld

Mand

Kühne

et al. 2018

Transfus Med Hemother

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Background: Immediate supply of red blood cell (RBC) concentrates is crucial in the initial treatment of exsanguinating patients in the emergency room. General shortage of RhD- RBCs has led to protocols in which patients with unknown blood groups are initially transfused with group O, RhD+ RBCs. Limited data are available regarding the safety of such an approach. Methods: Transfusion protocols for all multiple injured patients from the regional polytrauma database were retrospectively analyzed over a period of 5 years. Data on side effects were retrieved from the local safety update registry. Follow-up data were obtained from patients with identified RhD-incompatible transfusions. Results: In total, 823 patients were registered as multiple injured in the database. An immediate transfusion of 259 units (mean number of units 4, range 1-6) group O, RhD+ RBCs was initiated in 62 of them. 14 of these patients were RhD- and received 60 units of RhD-incompatible RBCs in the emergency room. In the later course RhD- patients received additional 185 incompatible transfusions (13; 1-31). The overall seroconversion rate was 50%. No adverse outcome due to incompatible transfusion was observed. Conclusions: Initial supply with group O, RhD+ RBCs in multiple injured patients appears to be safe. Significant numbers of RhD- units can be saved for use in other patients.

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Section: Introductionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Unmatched Type O RhD+ Red Blood Cells in Multiple Injured Patients

Flommersfeld

Mand

Kühne

et al. 2018

Transfus Med Hemother

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“…The MDmulticard Basic Extended Phenotype might become an equal or even superior alternative for such purposes. Moreover, the MDmulticard system could not only be adequate for blood typing in emergency situations [4,8,9,10] and extreme environment conditions [22], but could also be more cost-effective, as it limits the number of genotyping investigations necessary (and therefore the costs) to provide antigen-matched blood, especially for patients with autoantibodies or sickle cell disease. However, this should be confirmed by studies specifically aimed to cost and time analyses [23].…”

Section: Discussionmentioning

confidence: 99%

“…The development and improvement of tools for rapid and reliable blood typing adequate for use in acute clinical situations is warranted [4]. In a step further to the MDmulticard that determines a patient's main antigens (ABO, Rh phenotype and K) within a few minutes [7], the new MDmulticard Basic Extended Phenotype covers an additional array of clinically significant antigens [11] through the same lateral flow principle.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the New Lateral Flow Card MDmulticard® Basic Extended Phenotype in Routine Clinical Practice

Mayer

Müller

Candela-García

et al. 2018

Transfus Med Hemother

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Background: Transfusion emergencies and critical situations require specifically designed devices to simplify and optimize the standard procedures. In addition, matching antigens over and above ABO-Rh-K would be beneficial. Methods: Routine blood samples were collected in four immunohematology centers and tested with the new MDmulticard Basic Extended Phenotype for the simultaneous detection of the Duffy, Kidd, and Ss antigens, according to the principle of the lateral flow. Results were compared with those obtained using routine serology methods. Discrepancies were analyzed by molecular techniques/genotyping. Results: 310 samples were tested (167 donors; 75 patients; 28 subjects with positive direct antiglobulin test (DAT); 15 newborns; 25 previously transfused patients). The 285 samples with non-mixed-field reaction yielded 1,710 antigen results with 8 discrepancies (0.47%) six of which in DAT-positive subjects: three false-positive (Fy^a) for MDmulticard, and two false-positive (Fy^a) plus three false-negative (Fy^b) for the reference methods (MDmulticard PPA for donors/patients/newborns: 99.82%; negative percent agreement: 100%; sensitivity: 100%; specificity: 99.39%, positive predictive value: 99.75%; negative predictive value: 100%). The MDmulticard detected mixed-field in 15 antigen reactions from 13 transfused patients, undetected by the comparative method, with the opposite result in 8 antigens (5 patients). Conclusion: The MDmulticard Basic Extended Phenotype met the criteria prescribed for the testing of donor, patient, DAT-positive, and newborn samples in transfusion laboratory routine.

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緊急輸血後にRh不適合輸血が判明した危機的大量出血の1症例(A case of critical bleeding with D–mismatched transfusion discovered after emergency transfusion)

健夫

庸郎

麻紀

et al. 2018

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨近年とくに外傷領域において，血液型判明前に緊急輸血が実施されることが増えている。しかし，本邦ではRh陰性の血液が不足しており，緊急輸血ではやむを得ずRh陽性の血液が用いられる。緊急輸血実施後に患者の血液型がRh陰性であることが判明する事例は一定の確率で起こると予測されるが，本邦ではほとんど報告されていない。症例は20歳代の女性，多部位刺創による出血性ショックのために，当院救命救急センターへ搬送された。主な損傷部位は，右顔面動脈損傷，右内頸静脈損傷，両肺損傷であった。血液型判明前にO型Rh陽性の濃厚赤血球，AB型Rh陽性の新鮮凍結血漿を急速投与したが，ショックから離脱できず，可及的速やかに止血術を実施した。術中に患者の血液型がO型Rh陰性であることが判明したが，出血が持続しており，十分な同型輸血を確保することは不可能と判断し，引き続きRh陽性の血液を投与した。手術終了までに，濃厚赤血球計70単位，新鮮凍結血漿計80単位，血小板計80単位を要した。術後は定期的な血液検査を行ったが，溶血を含む有害事象を呈することはなかった。第53病日に抗D抗体が陽性となった。Rh不適合輸血の安全性を検証した報告はいくつか見られるが，いずれも有害事象を認めていない。危機的大量出血に対してRh不適合輸血を実施することは許容される。不適合輸血実施後は，適切なフォローアップを行うべきである。

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Emergency uncrossmatched transfusion effect on blood type alloantibodies

Cited by 25 publications

References 18 publications

Unmatched Type O RhD+ Red Blood Cells in Multiple Injured Patients

Unmatched Type O RhD+ Red Blood Cells in Multiple Injured Patients

Evaluation of the New Lateral Flow Card MDmulticard® Basic Extended Phenotype in Routine Clinical Practice

緊急輸血後にRh不適合輸血が判明した危機的大量出血の1症例(A case of critical bleeding with D–mismatched transfusion discovered after emergency transfusion)

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