Incorrect blood typing and mis-transfusion due to low-titer group O whole blood resuscitation

Resuscitation strategies for massive hemorrhage increasingly involve the use of low-titer group O whole blood (LTOWB) due to evidence suggesting improved patient outcomes. However, the potential risk of incorrect ABO typing following LTOWB administration, possibly leading to mis-transfusion, remains insufficiently explored. This case series aims to highlight the potential risk of ABO mistyping associated with LTOWB transfusions in trauma settings.

We retrospectively reviewed three cases involving trauma patients who received LTOWB transfusions at a high-volume urban Level 1 Trauma Center. ABO and RhD typing were performed using automated column agglutination technology (Ortho ID-MTS™), and discordant typing results prompted further investigations to confirm patients' true ABO type and identify mis-transfusions.

All three patients initially received LTOWB due to traumatic hemorrhage. Initial ABO typing after LTOWB administration incorrectly identified the patients as group O. Follow-up investigations later confirmed their true blood types as group A. Two cases resulted in subsequent inadvertent transfusions of ABO-incompatible plasma. Although no severe adverse clinical outcomes occurred, these events were reported to regulatory bodies as biologic product deviations.

Our findings highlight a rare but clinically significant risk of ABO typing errors following LTOWB transfusion, primarily due to contamination of patient samples with donor blood. Such errors carry the potential for acute hemolytic reactions, underscoring the critical need for strict adherence to sampling protocols. Whenever possible, ABO typing should be performed prior to LTOWB administration, and samples should be drawn from a site contralateral to the transfusion.