Sabine Flommersfeld1, Carsten Mand2, Christian A Kühne3, Gregor Bein4, Steffen Ruchholtz2, Ulrich J Sachs1,4. 1. Center for Transfusion Medicine and Hemotherapy, University Hospital Gießen and Marburg, Marburg Campus, Marburg, Germany. 2. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen and Marburg, Campus Marburg, Marburg, Germany. 3. Asklepios Klinik Wandsbek, Hamburg, Germany. 4. Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Gießen, Germany.
Abstract
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.
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.
Entities:
Keywords:
Alloimmunization; Emergency transfusion; Non-cross-matched transfusions; Type O RhD+ supply
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