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Use of O Negative Red Blood Cells in the Emergency Release Blood Transfusion Setting

Mar 31, 2014
  • At the Baptist Health System our policies dictate the use of O negative red blood cells (universal donor) in the situations where patients cannot wait for fully cross-matched units to become available.
  • O negative units provide the safest solution to patients who cannot wait for fully cross matched red blood cells.
  • The use of “type-specific” red blood cells in the emergency release transfusion situation is not recommended because there is an increased danger of an acute hemolytic transfusion reaction due to ABO incompatibility.
  • It is known that most ABO incompatibility acute hemolytic transfusion reactions are due to clerical errors.
  • In order to expedite blood delivery in the emergency release transfusion setting, clerical checks are largely eliminated, thus “type-specific” units present an increased risk to the patient when compared to the use of O red blood cell units.
  • Further, in the emergency release transfusion setting, “type-specific” units that are issued without a blood-loc apparatus into a busy patient care setting can also increase risks for other patients in the immediate treatment area if blood is mistakenly given to another patient.
  • If a departure from routine emergency release procedure is needed (say, due to supply shortages of O negative, for example), the on-call pathologist must be notified and pre-approval of the process change must be obtained.
  • If a patient has previously formed antibodies and needs emergency release RBCs, the use of uncrossmatched “type-specific” vs. O negative units will not decrease the risk of developing new antibodies or transfusion reactions.
  • Summary: O negative units provide the safest solution to patients who cannot wait for fully cross matched red blood cells.

Emily E. Volk, MD
Medical Director, Department of Pathology and Laboratory Medicine
Baptist Health System
San Antonio, Texas

References: http://www.redcrossblood.org/learn-about-blood/blood-facts-and-statistics

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