An Experience of Various Pretransfusion Test Protocols in a Tertiary Referral Hospital / 대한수혈학회지

BACKGROUND: Pretransfusion tests are essential for safe transfusions, but occasionally, part or all can be omitted when a transfusion is needed urgently in an emergency. The purpose of this study was to share the authors' experience of various pretransfusion test protocols in a tertiary referral hospital in Korea. METHODS: From July 2016 to June 2017, all transfusion cases at Samsung Medical Center were analyzed retrospectively. For each pretransfusion test protocol, the parameters regarding issue, return and disposal rate of blood products, occurrence of hemolytic transfusion adverse effect, and prescription frequency of each respective department and ordering site were analyzed. RESULTS: A total of 90,539 units of red blood cells, 24,814 units of fresh frozen plasmas, 24,758 units of single donor platelets, and 23,303 units of platelet concentrates were issued during the study period. Among them, 3.6%, 1.8%, 0.3%, and 0.4% of red blood cells, fresh frozen plasmas, single donor platelets, and platelet concentrates were issued according to the emergency transfusion protocols. When various pretransfusion test protocols were applied to issue blood products, there was no case in which an adverse hemolytic transfusion reaction was suspected. When compared with usual pretransfusion test protocol, all emergency transfusion protocols showed significantly higher return and wastage rates in red blood cells and fresh frozen plasmas. Platelets also had a higher return and wastage rate, but the difference was not significant. CONCLUSION: These results suggests that there is no different risk of adverse hemolytic transfusion reaction regardless the pre-transfusion protocols, but management about of the increased rate of return and wastage of blood products in emergency transfusions should be considered.

The Usage of Uncrossmatched Group O, Rh-Negative RBCs for Emergency Transfusion / 대한수혈학회지

BACKGROUND: The use of uncrossmatched group O, Rh-negative RBCs has enabled immediate transfusion of patients who need critical care in life-threatening situations. We examined our 1-year experience with uncrossmatched group O, Rh-negative RBC transfusion in a tertiary care university hospital. METHODS: Uncrossmatched group O, Rh-negative RBCs were available for immediate transfusion upon request without performing any of the following pretransfusion tests: ABO and RhD typing, irregular antibody screening, crossmatching test. The characteristics of the transfused patients were studied retrospectively. RESULTS: Twenty-five patients received 56 units of uncrossmatched group O, Rh-negative RBCs from November 2005 to October 2006. An average of 2.24 units was issued to each patient, with no more than 4 units per patient being given; subsequent transfusion was done with type-specific, crossmatched blood. The average turnaround time for the release of uncrossmatched group O, Rh-negative RBCs was 1.8 minutes (mean+/-standard deviation: 1.8+/-1.96, range: 0~7 minutes). Seventeen patients died (68%), which included 16 patients who had received cardiopulmonary resuscitation. CONCLUSION: Patients admitted for traffic accident, falling down injury, gastrointestinal bleeding and aortic dissection received 72% of the emergency group O, Rh-negative RBCs, with a 72.2% mortality rate, which indicates the dire condition of these patients. The majority of RBCs for transfusion were available within 5 minutes upon request. Though group O, Rh-negative RBCs are recommended in emergency situations in which the blood group of the patient is unknown, the use of group O, Rh-positive RBCs may be an alternative blood supply, when considering the short supply of Rh-negative RBCs.

Analysis of Immediate-Spin Crossmatched Blood for Emergency Transfusions / 대한임상병리학회지

Backgroud: To evaluate the appropriateness of the requests of the emergency transfusions, 3 year experiences in the use of the immediate-spin crossmatched blood(ISMB) for emergency transfusions in tertiary hospital were reviewed. METHODS: Low-isotonic salt solution was used as a cell suspension and crossmatchings were continued including antiglobulin phase after issuing of the ISMB. The number of cases, the issuing time, sex, age, reasons for emergency transfusions and vital signs of the patients were retrospectively reviewed. Only cases of massive transfusions and classes III and IV according to the Advanced Trauma Life Support(ATLS) classification were considered appropriate. RESULTS: 1. The total number of emergency transfusions were 614 and 0.53 cases per day. The average age of the patients was 44.7+/-17.8 and male to female ratio was 2:1. And 357 cases(58.2%) were performed during off hours when the hospital was not fully staffed. 2. Six hundred thirteen cases(99.8%) were transfused with compatible blood. However, one case(0.2%) was found to have anti-E antibody during the emergency transfusion. 3. Massive transfusion was performed only in 32% of the total cases and the reasons of emergency transfusions in remaining cases were upper gastrointestinal bleeding(53%), trauma(19.2%) and obstetrical problems(16.8%). 4. Of the total 519 cases reviewed, 392 cases(75.5%) were considered appropriately, and 127 cases(24.5%) were considered inappropriately selected for emergency transfusions. CONCLUSIONS: One fourth of emergency transfusions was found to be inappropriate. We believe that the use of ISMB for emergency transfusions should be carefully requested by physicians and educational programs for the use of ISMB is clearly indicated for emergency transfusion management.