By Anna Wonnerth, MD - 20th Jan 2019 - Course previews

Handling urgent transfusions

When a patient needs a transfusion urgently, how do you proceed when you don't have time to check compatibility? In this video, you'll understand when blood components without full compatibility testing are given and what the implied risks are.

Confidently choose the right blood product for your patient at the right time with our Transfusion Medicine Essentials course. You'll master the administration of blood products, understand how blood typing works, when it's ok to skip some parts of the testing, how to deal with complications, blood group constellations in pregnancy and apply your knowledge to real-life patient cases.

 

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VIDEO TRANSCRIPT

[00:00:00] If your patient needs blood urgently that means right now otherwise they'll die, there's a special protocol to following which uncrossmatched RBC units are transfused. This is also called Emergency Release. In general, there is no time to lose, so what should you do? First, get in contact with the lab and communicate clearly how urgent the transfusion is. [00:00:30] Then, send them one specimen of currently drawn blood right away. Depending on how urgent the situation really is, that means how fast the patient needs blood, the lab will provide you with either group O, uncrossmatched blood units if there is no time to complete any typing test, or blood type compatible but uncrossmatched blood units if the clinical situation allows for a quick blood typing evaluation, which typically takes about 10 to 30 minutes. [00:01:00]  

Whether to release units or rhesus D positive or negative depends on availability and institutional policies. However, young girls and women of childbearing age should always receive rhesus negative blood until their rhesus status is known. Following these rules, you will have chosen the blood type that has the least potential to do harm; however, using group O blood does not mean that the transfusion is completely safe. [00:01:30] As you know there are over 30 different blood groups and the patient could have alloantibodies to other blood group antigens that could react with the unit you give them. Following ABO mismatches, the most severe transfusion reactions are caused by alloantibodies against the rhesus, Kell, Kidd (abbreviated Jk), Duffy (abbreviated Fy), Lutheran, and S blood group systems.

Normally, you would uncover these alloantibodies [00:02:00] in the antibody screen and eventually in the crossmatch; however, neither of these will be performed in this time-sensitive situation. Nevertheless, it is an urgent life-threatening situation. You don't have time to be afraid. The best you can do is to choose the most compatible unit based on the information you do have. Although there is a chance your patient could develop a reaction to one of these other blood group antigens, the benefit of saving the patient's life, [00:02:30] by giving the blood transfusions, will always be higher than the risk of adverse reactions due to this type of incompatibility.

There are two more things you should remember to do before you start the emergency transfusion. First, remember that you must take a blood sample before starting any transfusion. This sample is very important. It allows the lab to type the patient's blood group. Furthermore, it allows switching to group specific crossmatch [00:03:00] blood as soon as possible. And lastly, transfused uncrossmatched blood units can be retrospectively crossmatched with this sample, and in the case that potential incompatibilities are found, the patient will be monitored more closely. Second, be aware that in countries where bedside blood typing is obligatory, bedside task should also be completed before performing emergency transfusions.

Managing patients with life-threatening bleedings [00:03:30] is definitely one of the most stressful situations in the hospital. My recommendations, work with the Emergency Release protocols. They will help you stay structured, and don't forget to talk to your lab. Good communication between clinicians at the bedside and the lab staff can save lives.