Use of Uncrossmatched Erythrocytes in Emergency Bleeding Situations.

<zdoi;10.1097/ALN.0000000000002037> Anesthesiology, V 128 • No 3 650 March 2018 Copyright © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. Anesthesiology 2018; 128:650–6 U NCROSSMATCHED 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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