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Question of the Day
A 24-year-old G1P0 woman at 39 weeks gestation arrives to the emergency department in active labor with heavy vaginal bleeding. Her BP is 70/40 mmHg and her HR is 130 bpm. She is found to have complete placenta previa. Her hemoglobin is 5 mg/dL. From her prenatal OB care, her blood type is known to be AB negative. While awaiting type-specific blood products for transfusion, what is the maximum number of uncrossmatched O negative packed red blood cells units that she can receive and still switch back to type-specific blood?
Explanation
In a hemodynamically unstable patient with ongoing bleeding, if crossmatched, type-specific blood is not available, uncrossmatched O negative packed red blood cells may be transfused. O negative whole blood and O negative plasma containing products should be avoided as some type O donors produce high titers of anti-A and anti-B antibodies. After a patient has received 2 units of uncrossmatched O negative blood, the patient should not be switched back to their type-specific blood and additional transfusions should use type O blood until the blood bank can determine that switching back to type-specific blood is safe.
References:
Boisen ML, Collins RA, Yazer MH, Waters JH. Pretransfusion testing and transfusion of uncrossmatched erythrocytes. Anesthesiology. 2015;122(1):191-195. doi:10.1097/ALN.0000000000000414 Blood Product ModificationsMiller RD, ed. Miller’s Anesthesia, 8th ed. Philadelphia: Churchill Livingstone; 2015: 1830-1867.
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