Contributions
Abstract: PB2534
Type: Publication Only
Background
Pre-transfusion compatibility testing is performed to provide appropriate blood components. Compatibility testing certainly includes the determination of ABO and Rh types, antibody screening of the patient's plasma for any unexpected anti-RBC antibodies and a crossmatching test using the patient's plasma and the donor RBCs to determine if they are compatible.If no compatible cross-matched blood can be found, clinicians may avoid transfusion and consultation by the hematology department is generally required. The majority of clinicians usually choose to transfuse group O, Rh(D)-negative.Another option is to separate the most compatible or the least incompatible blood and start the transfusion with this. Nevertheless, it is not clear how safe the least incompatible transfusion is, and whether it provides the targeted hemoglobin increments. It has also not been fully clarified whether acute hemolytic transfusion reactions can be ignored.
Aims
The aim of this study was to determine the safety and efficacy of the least incompatible cross-matched blood transfusion, through the use of biological in vivo cross-match testing.
Methods
The study included 18 patients with incompatible cross-matching who were transfused RBC.A total of 55 units of RBC were transfused.Red blood cell concentrates were included in saline-adenine-glucose-mannitol (SAG-M). None of the patients had any premedication such as steroids or antihistamines before transfusion. From the selected incompatible unit, 20 ml blood was collected in a 20 cc syringe(Hayat®) and infused intravenously to the patient in 10 minutes via the antecubital vein. Patients were observed for any signs of acute hemolysis for 20 minutes before the initiation of the transfusion of the residual blood. The transfusions were started from another vascular access and were completed in 2 hours. Each transfusion was observed by medical professionals to identify any evidence of acute hemolysis. Possible acute transfusion reactions were listed on a form (Figure 1: patient transfusion form) including dyspnea, headache, hypotension, back pain, fever, tachycardia, and chills, and these were recorded together with the time of occurrence by the observer.If any symptoms indicating hemolysis were observed, the transfusion was stopped and another selected unit of blood was used. Pre- and post-transfusion hemoglobin and hematocrit levels were compared to determine the increase as a result of the transfusion. Biochemical markers indicating hemolysis, such as lactate dehydrogenase and total-indirect bilirubin levels were recorded to evaluate the hemolytic state. The laboratory test results were reported within 24 hours of the transfusion.
Results
A No complications or signs were observed in any of the 55 transfusions and all the transfusions were completed succesfully.An appropriate increase in hematocrit and hemoglobin was seen post-transfusion (p:0.001). As indicators of hemolysis, lactate dehydrogenase (LDH) and bilurubin levels were determined to have significantly increased post transfusion (p:0.035, p:0.001).
Conclusion
Acute hemolytic transfusion reactions are a serious situation which can result in mortality. When pre-transfusion tests result in ABO compatibilty and are cross-match incompatible, clinicians should not avoid transfusion if it is urgently required. The biological in vivo compatibility test seems to be a procedure which is safe, predictive, and can be feasibly applied at the bedside, and could be life-saving for many patients.
Session topic: 32. Transfusion medicine
Keyword(s): ABO blood group, Blood transfusion
Abstract: PB2534
Type: Publication Only
Background
Pre-transfusion compatibility testing is performed to provide appropriate blood components. Compatibility testing certainly includes the determination of ABO and Rh types, antibody screening of the patient's plasma for any unexpected anti-RBC antibodies and a crossmatching test using the patient's plasma and the donor RBCs to determine if they are compatible.If no compatible cross-matched blood can be found, clinicians may avoid transfusion and consultation by the hematology department is generally required. The majority of clinicians usually choose to transfuse group O, Rh(D)-negative.Another option is to separate the most compatible or the least incompatible blood and start the transfusion with this. Nevertheless, it is not clear how safe the least incompatible transfusion is, and whether it provides the targeted hemoglobin increments. It has also not been fully clarified whether acute hemolytic transfusion reactions can be ignored.
Aims
The aim of this study was to determine the safety and efficacy of the least incompatible cross-matched blood transfusion, through the use of biological in vivo cross-match testing.
Methods
The study included 18 patients with incompatible cross-matching who were transfused RBC.A total of 55 units of RBC were transfused.Red blood cell concentrates were included in saline-adenine-glucose-mannitol (SAG-M). None of the patients had any premedication such as steroids or antihistamines before transfusion. From the selected incompatible unit, 20 ml blood was collected in a 20 cc syringe(Hayat®) and infused intravenously to the patient in 10 minutes via the antecubital vein. Patients were observed for any signs of acute hemolysis for 20 minutes before the initiation of the transfusion of the residual blood. The transfusions were started from another vascular access and were completed in 2 hours. Each transfusion was observed by medical professionals to identify any evidence of acute hemolysis. Possible acute transfusion reactions were listed on a form (Figure 1: patient transfusion form) including dyspnea, headache, hypotension, back pain, fever, tachycardia, and chills, and these were recorded together with the time of occurrence by the observer.If any symptoms indicating hemolysis were observed, the transfusion was stopped and another selected unit of blood was used. Pre- and post-transfusion hemoglobin and hematocrit levels were compared to determine the increase as a result of the transfusion. Biochemical markers indicating hemolysis, such as lactate dehydrogenase and total-indirect bilirubin levels were recorded to evaluate the hemolytic state. The laboratory test results were reported within 24 hours of the transfusion.
Results
A No complications or signs were observed in any of the 55 transfusions and all the transfusions were completed succesfully.An appropriate increase in hematocrit and hemoglobin was seen post-transfusion (p:0.001). As indicators of hemolysis, lactate dehydrogenase (LDH) and bilurubin levels were determined to have significantly increased post transfusion (p:0.035, p:0.001).
Conclusion
Acute hemolytic transfusion reactions are a serious situation which can result in mortality. When pre-transfusion tests result in ABO compatibilty and are cross-match incompatible, clinicians should not avoid transfusion if it is urgently required. The biological in vivo compatibility test seems to be a procedure which is safe, predictive, and can be feasibly applied at the bedside, and could be life-saving for many patients.
Session topic: 32. Transfusion medicine
Keyword(s): ABO blood group, Blood transfusion