Transfusion of Uncrossmatched Group O Erythrocyte-containing Products Does Not Interfere with Most ABO Typings
Mark H Yazer1, Philip C Spinella, Leilani Doyle
1From Vitalant, Pittsburgh, Pennsylvania (M.H.Y., D.J.T.) the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (M.H.Y., D.J.T.) the Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, St Louis, Missouri (P.C.S.) the Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada (L.D.) Canadian Field Hospital, Canadian Armed Forces, Ottawa, Ontario, Canada (L.D.) the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (R.M.K.) the Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California (R.D., A.Z.) the Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington (J.R.H., E.E.T.) Hemorio, Rio de Janeiro, Brazil (L.A.F.) the Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland (M.F., J.P.) the Institute of Transfusion Medicine, University of Cologne, University Hospital, Cologne, Germany (B.G.) the Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (B.J.) National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, United Kingdom (J. Staves) the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina (J.S.R.) the Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada (K.R., A.W.S.) the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (J. Seheult) the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.W.S.) the Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (J. Sperry). Current affiliation: Department of Pathology, University of New Mexico, Albuquerque, New Mexico (J.S.R.).
Background:
Group O erythrocytes and/or whole blood are used for urgent transfusions in patients of unknown blood type. This study investigated the impact of transfusing increasing numbers of uncrossmatched type O products on the recipient's first in-hospital ABO type.
Methods:
This was a retrospective cohort study. Results of the first ABO type obtained in adult, non-type O recipients (i.e., types A, B, AB) after receiving at least one unit of uncrossmatched type O erythrocyte-containing product(s) for any bleeding etiology were analyzed along with the number of uncrossmatched type O erythrocyte-containing products administered in the prehospital and/or in hospital setting before the first type and screen sample was drawn.
Results:
There were 10 institutions that contributed a total of 695 patient records. Among patients who received up to 10 uncrossmatched type O erythrocyte-containing products, the median A antigen agglutination strength in A and AB individuals on forward typing (i.e., testing the recipient's erythrocytes for A and/or B antigens) was the maximum (4+), whereas the median B antigen agglutination strength among B and AB recipients of up to 10 units was 3 to 4+. The median agglutination strength on the reverse type (i.e., testing the recipient's plasma for corresponding anti-A and -B antibodies) was very strong, between 3 and 4+, for recipients of up to 10 units of uncrossmatched erythrocyte-containing products. Overall, the ABO type of 665 of 695 (95.7%; 95% CI, 93.9 to 97.0%) of these patients could be accurately determined on the first type and screen sample obtained after transfusion of uncrossmatched type O erythrocyte-containing products.
Conclusions:
The transfusion of smaller quantities of uncrossmatched type O erythrocyte-containing products, in particular up to 10 units, does not usually interfere with determining the recipient's ABO type. The early collection of a type and screen sample is important.
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