Clinical outcomes of ABO-incompatible RBC transfusions.

Area of Science:

• Transfusion Medicine
• Immunology
• Patient Safety

Background:

• Predicting outcomes of ABO-incompatible red blood cell (RBC) transfusions remains challenging.
• Understanding the relationship between transfusion volume and patient response is crucial for improving safety.

Observation:

• A 35-year review of ABO-incompatible RBC transfusions, including institutional data and a survey of blood centers, was conducted.
• All identified ABO-incompatible transfusions resulted from errors, with a majority occurring at the patient's bedside.

Findings:

• Patients receiving over 50 mL of incompatible blood had a 64% rate of adverse signs/symptoms and a 17% mortality rate.
• Patients receiving 50 mL or less of incompatible blood had only a 25% rate of adverse signs/symptoms and no reported deaths.
• Hypotension, hemoglobinuria, and hemoglobinemia were common findings in both survivors and non-survivors.

Implications:

• ABO-incompatible RBC transfusion does not invariably lead to severe symptoms or death.
• Prompt identification and cessation of incompatible transfusions are critical for mitigating adverse events.
• Minimizing the volume of ABO-incompatible blood transfused can significantly reduce patient morbidity and mortality.