Emergent blood transfusion with Group O

Q: A 32-year-old male is admitted to the ICU with severe life-threatening shock after an esophageal variceal bleed. Emergency release of blood is ordered. The blood bank informed you that, unfortunately, no Group O, RhD-negative blood is available. Can Group O, RhD-positive blood be transfused?

A) Yes

B) No

Answer: A

In case of emergency, blood released from the bank is typically group O, RhD-negative. But in a situation like our patient in the above question, group O, RhD-positive RBC units can be used. It is popularly known as low-titer O-positive whole blood (LTO+WB). Many blood banks use this approach to preserve O-negative blood units for childbearing women in emergencies.

Also, patients with a confirmed ABO type on a current specimen can receive uncrossmatched, type-specific blood for emergency release. 

In all such situations, pRBC should be infused slowly, with close monitoring for signs of an acute hemolytic transfusion reaction, such as fever, chills, hypotension, hematuria, or chest or flank pain.

#hematology

References:

1. Chowdhury R, Williams BA, Williams S, Casey J. Quality improvement review of O positive blood in emergency transfusion. Transfusion. 2023 Oct;63(10):1841-1848. doi: 10.1111/trf.17537. Epub 2023 Sep 12. PMID: 37698202.

2. Flommersfeld S, Mand C, Kühne CA, Bein G, Ruchholtz S, Sachs UJ. Unmatched Type O RhD+ Red Blood Cells in Multiple Injured Patients. Transfus Med Hemother. 2018 May;45(3):158-161. doi: 10.1159/000485388. Epub 2018 Mar 7. PMID: 29928169; PMCID: PMC6006622.

3. Courcelles L, Pouplard M, Braun O, Streel C, Deneys V. Optimizing O red blood cell concentrate usage in the emergency department in the era of patient blood management. Hematol Transfus Cell Ther. 2024 Nov;46 Suppl 5(Suppl 5):S90-S96. doi: 10.1016/j.htct.2024.05.008. Epub 2024 Aug 21. PMID: 39183144; PMCID: PMC11670554.