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Uncross-matched Blood Saves Lives

Uncross-matched Blood Saves Lives. John R. Hess, MD, MPH, FACP, FAAAS Professor of Pathology and Medicine U of Maryland School of Medicine. Blood Use in World War I. Robertson and the Harvard Medical Unit officers in 1917. Robertson Bottle – Aug 1917. The first blood bank Cambrai

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Uncross-matched Blood Saves Lives

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  1. Uncross-matched BloodSaves Lives John R. Hess, MD, MPH, FACP, FAAAS Professor of Pathology and Medicine U of Maryland School of Medicine

  2. Blood Use in World War I Robertson and the Harvard Medical Unit officers in 1917

  3. Robertson Bottle – Aug 1917

  4. The first blood bank Cambrai Nov 1917.

  5. The Robertson method of blood transfusion became official British Army medical policy in March 1918

  6. Blood Transfusion at St. Vitesse – 18 July 1918 Canadian Army Painter – Pvt. Arthur Elias - 1918

  7. Universal Donor Blood • More than 100,000 U of Group “O” RBC were given as universal donor blood in Vietnam without a single hemolytic transfusion reaction. Recipients were mostly young, healthy males. • All 9 fatal hemolytic transfusion reactions in Vietnam occurred as a result of crossmatching errors, usually in multi-casualty situations. • Use universal donor blood in mass casualty situations!

  8. Injury & blood use: the national numbers • 36 million Americans are injured each year • 27 million seek emergency medical care • 2.7 million are hospitalized • 200,000 receive blood • 1.75 million U of RBC are used to treat injury • 93,000 die

  9. Blood Use at STC in 2000Transfusion 2004; 44:809-813 • About 7200 patients admitted • 5645 admitted directly from scene of injury • 514/5645 received blood products • 490 received RBC • remainder received plasma (elderly on warfarin with intracranial bleeding, etc)

  10. 5219 RBC units were given to 490 of the 514 transfused patients among the 5645 patients admitted directly from the scene of injury in the year 2000.

  11. The relationship between injury severity, blood use and mortality

  12. Grade V liver injury has a 76% mortality in academic Level 1 Trauma Centers

  13. Abdominal packing after damage control surgery

  14. In the angiography suite, bleeding from arterial sites in solid organs can be embolized. At this point in his treatment, this patient had received 54 U of RBC He lived.

  15. Hemorrahge Resuscitation Coagulopathy Hemodilution & Hypothermia “Bloody vicious cycle”

  16. Among 490 patients receiving 5219 U RBC, the fraction receiving plasma reaches 95% at 10 U of RBC. In all subgroups, the ratio of Plasma U to RBC U is essentially one. 309 patients used 5226 U Plasma.

  17. Among 490 patients receiving 5311 U RBC, 154 received platelets. The fraction receiving platelets reaches 75% at 10 U & 95% at 20 U of RBC. The 756 random donor and 356 pheresis U are equivalent to 2892 U of platelets.

  18. Whole blood 500 mL Hct 38-50% Plts 150-400K Plasma coag factors = 100% Components 1 U pRBC = 335 mL with Hct 55% 1 U platelets = 50mL with 5.5 x 1010 plts 1 U plasma = 275mL with 80% coag activity Dilution is inevitable when giving blood components Thus: 1U pRBC + 1U platelets + 1U FFP = 660mL with Hct 29%, Plts 88K/µL, and Coag activity 65%.

  19. Hemorrhage Coagulo- pathy Resuscitation Hemodilution & Hypothermia Breaking the Bloody Vicious Cycle • Control hemorrhage • Use best possible resuscitation products • Prevent hypothermia • Prevent hemodilution • Treat coagulopathy

  20. Uncrossmatched Group O RBC • 161/490 patients transfused RBC at STC in CY 2000 received initial treatment with uncrossmatched group O RBC (umORBC) • 18% of all RBC given on first day were umORBC • 11% of all RBC given in STC are umORBC • 55% of patients who receive umORBC during resuscitation at STC survive

  21. Management of Uncrossmatched Group O RBC • We stock 10 U of O Pos and 2 U of O Neg RBC in the STC refrigerator • O Neg units are given to women of child-bearing age, all others receive O Pos • More uncrossmatched units can be released by calling the blood bank • Turn-around time for crossmatched blood is 45-50 minutes. • Blood bank is two blocks away

  22. Safety of Uncrossmatched Group O RBC • No hemolytic transfusion reactions, always a concern in chaotic situations where identification is difficult. • Alloimmunization is rare. 9 cases of new anti-D among 800 patients in 5 years. • No woman of reproductive age alloimmunized in 5 years.

  23. Uncrossmatched RBC saves lives • Bleeding remains the major cause of preventable death following injury. • Immediate provision of oxygen transport capacity as RBC delays the onset of hemodilution and coagulopathy. • For patients who need RBC, there are no plausible alternatives. • Even short term reductions in the rate of hemorrhage buys time for other efforts and modalities.

  24. The staff of the Shock Trauma Center thank all those who work for traffic safety, violence control, a good blood supply, and injury care and research.

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