OFF-HOURS EMERGENCY TRANSFUSION MANUAL OF UNCROSSMATCHED BLOOD

Abstract

We introduced an automated instrument for pretransfusion testing during off-hours based on column agglutination technology. As the time required for testing ABO group and Rh type is at least 20 minutes, we also prepared manuals regarding emergency transfusion of uncrossmatched blood. During a two-year period, 25 patients received 209 units (8.4 units per patient) of group O blood, and 19 patients received 289 units (15.2 units per patient) of group-specific blood. Additionally, 5 patients received 98 units of group-specific blood following group O blood. Fourteen patients (26.9%) required massive transfusion (20 or more units of blood within 24 hours). Accurate blood typing was carried out by using a blood sample drawn from the patient prior to infusion of group O blood. Antibody screening was carried out using this specimen the next day, and if a patient was positive for an antibody, complete compatibility testing was also performed. All patients were followed clinically and for any signs of transfusion reactions or crossmatching difficulties, but none developed. Although one patient had anti-E antibody present on admission and received E antigen-positive blood, no elevation of antibody level or delayed hemolytic reaction occurred. Two near-miss incidents associated with clerical errors were experienced with group-specific blood transfusion. We conclude that urgent transfusion of uncrossmatched blood is safe, and that group O blood transfusion may be safer than group-specific blood transfusion in some emergency situations. Off-hour manuals based on the time required for blood preparation will avoid transfusion errors.