Uncrossmatched blood transfusions for trauma patients in the emergency department: incidence, outcomes and recommendations

Ball, Chad G.; Salomone, Jeffrey P.; Shaz, Beth H.; Dente, Christopher J.; Tallah, Clarisse; Anderson, Kelly K.; Rozycki, Grace S.; Feliciano, David V.

doi:10.1503/cjs.032009

Cited by 30 publications

(8 citation statements)

References 30 publications

(40 reference statements)

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“…Using the key words ‘uncross‐matched’ ‘emergency release’ and ‘transfusion reactions’, as well as a review of reference lists within relevant papers, we identified 12 studies (Blumberg & Bove, ; Gervin & Fischer, ; Schwab et al, ,b; Lefebre et al, ; Unkle et al, ; Dutton et al, ; Goodell et al, ; Ball et al, ; Miraflor et al, ; Radkay et al, ; Mulay et al, ) that evaluated the frequency of acute HTR following emergency receipt of uncross‐matched RBC units; a 13th study (Meyer & Uhl, ) evaluated the frequency of significant alloantibodies being present at transfusion. A 14th study (Schmidt et al, ) was brought to our attention during peer review of our manuscript.…”

Section: Methodsmentioning

confidence: 99%

Acute haemolysis, DIC and renal failure after transfusion of uncross‐matched blood during trauma resuscitation: illustrative case and literature review

Fiorellino

Elahie

Warkentin

2018

Transfusion Medicine

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Section: Methodsmentioning

confidence: 99%

Acute haemolysis, DIC and renal failure after transfusion of uncross‐matched blood during trauma resuscitation: illustrative case and literature review

Fiorellino

Elahie

Warkentin

2018

Transfusion Medicine

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“…Ball et al (2011) reported association of amount of uncrossmatched RBCs transfused with mortality, finding transfusion of more than 5 units of uncrossmatched RBCs consistent with 100% mortality. Two other researchers, Nunez et al (2010) and Inaba et al (2008) found transfusion of uncrossmatched RBCs to be an independent predictor of massive transfusion, defined as 10 RBCs within 6-12 hrs from ED presentation.…”

Section: Discussionmentioning

confidence: 99%

“…While limiting the overall sample size, the inclusion requirement of RBC transfusion targets potentially bleeding subjects more likely to receive MULT or traditional massive transfusion. This criterion is commonly used in previous studies of massive transfusion ( Ball et al, 2011 ;Callcut et al, 2013 ;Inaba et al, 2008 ;Larson et al, 2010 ;Nunez et al, 2009Nunez et al, , 2010Pommerening et al, 2015 ;Zink et al, 2009 ), including two recent, prospective, multicenter investigations .…”

Section: Methodsmentioning

confidence: 99%

“…Normal SI is 0.5-0.7, with an SI of more than 0.9 a marker of mortality in trauma patients ( Burman & Cotton, 2012 ;Cannon et al, 2009 ;Mutscher et al, 2013 ;Vandromme et al, 2011a ). Uncrossmatched (universal donor) RBCs are given for urgent transfusion of bleeding patients instead of waiting for crossmatch completion ( Ball et al, 2011 ;Inaba et al, 2008 ).…”

Section: Association Of Prehospital Shock Index and Trauma Bay Uncrosmentioning

confidence: 99%

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Association of Prehospital Shock Index and Trauma Bay Uncrossmatched Red Blood Cell Transfusion With Multiple Transfusion

Day

Anzelon

Conde

2016

Journal of Trauma Nursing

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Early resuscitation of bleeding trauma patients with multiple blood products improves outcome, yet transfusion initiation is not standardized. Shock index (heart rate/systolic blood pressure) and trauma bay uncrossmatched red blood cell (RBC) transfusion were evaluated for association with multiple transfusions, defined as 6 or more RBCs during the first 6 hrs of hospital presentation. A prehospital shock index of 1 was significantly associated with multiple transfusions (p = .02). Subjects receiving uncrossmatched RBCs required more RBCs during the first 6 hrs (10.3 units, p < .01). Consideration of these simple variables may help trauma nurses anticipate the potentially bleeding patient.

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“…Thirty-three of the 88 individuals received massive transfusion (> 10 packed RBC units) and/or had ongoing transfusions on arrival to the emergency room. As these individuals represented a clinically distinct cohort with higher hospital mortality(22–24), we excluded them from further analysis. We restricted our temporal analysis to subjects with at least 3 plasma samples within the first 48 h of admission in order to ensure an appropriate sampling for longitudinal analysis and to minimize any bias stemming from missing data.…”

Section: Methodsmentioning

confidence: 99%

Persistence of Elevated Plasma CXCL8 Concentrations Following Red Blood Cell Transfusion in a Trauma Cohort

Lee¹,

Sperry²,

Ochoa³

et al. 2012

Shock

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Red blood cell (RBC) transfusion is associated with alterations in systemic concentrations of IL-8/CXCL8 functional homologues in a murine model. Whether RBC transfusion alters systemic neutrophil chemokine concentrations in individuals sustaining traumatic injury is not known. We conducted a retrospective, single-center study of severely injured trauma patients presenting within 12 h of injury with a base deficit > 6 and hypotension in the field. Plasma concentrations of twenty-five chemokines, cytokines, and growth factors were obtained from both transfused (N=22) and non-transfused (N=33) groups in the first 48 h following admission. The transfused group (mean RBC units ± SD: 2.7 ±1.7) tended to be older (49.9 ±21.1 versus 40.4 ±19.9 years, p=0.10), with a higher percentage of females (40.9% versus 18.2%, p=0.06), and a higher injury severity score (ISS) (27.1 ±12.7 versus 21.4 ±10.2, p=0.07). In univariate and multivariate analyses, transfusion was associated with increased hospital and ICU length of stay but not ventilator-free days. Plasma CXCL8 concentrations were higher in the transfused (mean ±SD: 84 ±88 pg/mL) than the non-transfused group (31 ±21 pg/mL, p=0.003). Using a linear prediction model to calculate bioanalyte concentrations standardized for age, gender, ISS, and admission SBP, we observed that CXCL8 concentrations diverged within 12 hours following injury, with the transfused group showing persistently elevated CXCL8 concentrations by contrast to the decay observed in the non-transfused group. Other bioanalytes showed no differences across time. RBC transfusion is associated with persistently elevated neutrophil chemokine CXCL8 concentrations following traumatic injury.

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Uncrossmatched blood transfusions for trauma patients in the emergency department: incidence, outcomes and recommendations

Cited by 30 publications

References 30 publications

Acute haemolysis, DIC and renal failure after transfusion of uncross‐matched blood during trauma resuscitation: illustrative case and literature review

Acute haemolysis, DIC and renal failure after transfusion of uncross‐matched blood during trauma resuscitation: illustrative case and literature review

Association of Prehospital Shock Index and Trauma Bay Uncrossmatched Red Blood Cell Transfusion With Multiple Transfusion

Persistence of Elevated Plasma CXCL8 Concentrations Following Red Blood Cell Transfusion in a Trauma Cohort

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