Education  |   March 2018
Use of Uncrossmatched Erythrocytes in Emergency Bleeding Situations
Author Notes
  • From the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (M.H.Y.); the Department of Anesthesiology, University of Pittsburgh, Pennsylvania (J.H.W.); and the Department of Pediatrics, Division of Critical Care Medicine, Washington University in St. Louis, St. Louis, Missouri (P.C.S.).
  • U.S. Army Institute of Surgical Research, San Antonio, Texas
  • U.S. Armed Services Blood Program, Washington, DC
  • AABB, Bethesda, Maryland
  • Department of Surgery, Division of Trauma and Emergency Surgery, University of Texas San Antonio, San Antonio, Texas
  • AABB, Bethesda, Maryland
  • Department of Surgery, University of Colorado, Denver, Colorado
  • Johns Hopkins University School of Medicine, Baltimore, Maryland
  • Magen David Adom National Blood Services, Ramat Gan, Israel
  • Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
  • Department of Emergency Medicine, Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Submitted for publication July 18, 2017. Accepted for publication November 17, 2017.
    Submitted for publication July 18, 2017. Accepted for publication November 17, 2017.×
  • *Members of the AABB/THOR Working Party are listed in the appendix. The submission of this manuscript to Anesthesiology was approved by the AABB.
    Members of the AABB/THOR Working Party are listed in the appendix. The submission of this manuscript to Anesthesiology was approved by the AABB.×
  • Address correspondence to Dr. Spinella: Department of Pediatrics, Division of Critical Care Medicine, Washington University, 10th floor NWT, Box 8112, 1 Children’s Place, St. Louis, Missouri, 63110. pspinella@wustl.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Cardiovascular Anesthesia / Coagulation and Transfusion / Critical Care / Gastrointestinal and Hepatic Systems / Infectious Disease / Trauma / Burn Care / Clinical Focus Review
Education   |   March 2018
Use of Uncrossmatched Erythrocytes in Emergency Bleeding Situations
Anesthesiology 3 2018, Vol.128, 650-656. doi:10.1097/ALN.0000000000002037
Anesthesiology 3 2018, Vol.128, 650-656. doi:10.1097/ALN.0000000000002037
UNCROSSMATCHED erythrocytes are a lifesaving bridge between a hemorrhaging patient of unknown ABO blood group not receiving erythrocyte transfusions and the provision of crossmatched units. Unless the recipient’s ABO group is known, group O uncrossmatched erythrocytes will be issued, which are compatible with the preformed anti-A and/or anti-B (hemagglutinins) that are present in all recipients who are not blood group AB (table 1). Issuing group O erythrocyte units prevents acute, intravascular hemolytic reactions from occurring when uncrossmatched erythrocytes are transfused to a recipient of unknown ABO group. An acute (occurring within 24 h of the transfusion) intravascular reaction occurs when complement-fixing antibodies, such as the naturally occurring IgM isotype anti-A and/or anti-B found in all recipients who are not blood group AB, bind to their target antigen and fix complement, thereby causing the destruction of the erythrocytes inside the vascular system.1  These reactions can be life threatening because of the nature of the substances released from the lysed erythrocytes. In contrast, an extravascular hemolytic reaction is caused by IgG antibodies and tends to be less life threatening because the erythrocytes are destroyed in a contained manner in the liver and spleen, thereby not releasing intra-erythrocyte substances directly into the bloodstream. Thus, uncrossmatched erythrocytes can be administered to any patient with severe anemia or acute hemorrhage whose life would be compromised by waiting for crossmatched erythrocytes to become available. This Clinical Focus Review will briefly discuss how the blood bank performs pretransfusion testing, review the safety of using uncrossmatched erythrocytes in patients requiring urgent transfusions, and examine some newly emerging trends in the kinds of blood products that are used in the resuscitation of trauma patients.
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