Immediate transfusion without crossmatching

Introduction

We should perform red cell blood transfusion therapy (RC-BTF) only after crossmatching to decrease the whole risks of this treatment, particularly ABO-incompatible transfusion. In a rapid catastrophic bleeding condition, however, we often have to do this treatment without crossmatching and without establishment of ABO blood type. Our BTF manual (2002) states that the ABO blood type is confirmed only after double examinations, usually the first examination in the routine examination at admission or first visit to the hospital and the second in the procedure of crossmatching. Most of our medical staff have been afraid that type O RC-BTF was unacceptable for patients and their families. The aim of this study is to establish safety in the procedure of immediate RC-BTF without crossmatching and to clarify how we explain this safety to medical staff, patients and their families.

Methods

We examined the medical records of the patients who underwent immediate RC-BTF without crossmatching for the past 5 years in our Critical Care and Emergency Center. Data were the number of requested and used packed red cells (PRC) without crossmatching, adverse events of transfusion, and incidents concerning RC-BTF therapy.

Results

In 5 years in our Critical Care and Emergency Center, 1,036 units PRC were used for 109 cases without crossmatching. Type O RC-BTF without crossmatching before blood type detection was performed in 30 cases. These 109 patients underwent 9.42 units (mean) PRC without crossmatching. For patients who underwent RC-BTF without crossmatching at first and with crossmatching successively, 6.10 units (mean) of non-crossmatched PRC were transfused. On the other hand, for patients who underwent repeated RC-BTF without crossmatching, we required 7.03 units (mean) at first and excessive non-crossmatched units successively. In total, we actually used 85% of requested units of noncrossmatched PRC in immediate RC-BTF. No incompatible RC-BTF was performed, and eight incidents were noticed (error in sampling of blood, labeling on the examination tube, entering the data, and detecting the blood type).

Conclusion

Our manual for transfusion therapy is safe and useful. In immediate RC-BTF without crossmatching, we should use type O PRC, and we can make this therapy acceptable to medical staff in the hospital and patients and their families for step-by-step education.