Emergency Red Blood Cell Usage

Many hospitals in the Puget Sound area have a limited supply of uncrossmatched type O RBC’s to be used for a bleeding patient in dire emergency. Type O, Rh-negative RBC’s can be transfused to people of any type with only a slight risk of hemolysis. This risk increases in patients who have previously been transfused or pregnant and may have formed antibodies. At Harborview Medical Center a supply of uncrossmatched type O, Rh-positive RBC’s is also available. Type O, Rh-positive RBC’s can be used for women who are beyond childbearing age and in males over the age of 16. When Rh-positive RBC’s are used in an Rh-negative patient, there is a chance of a D immunization, and, therefore, should be used only in life-threatening emergencies. When type O, Rh positive RBC’s are available, the following algorithm should be followed:

1. For all patients under 16, use type O, Rh negative RBC’s. 2. For females under 50, use type O, Rh negative RBC’s. 3. For males older than 16 and women beyond childbearing, use type O, Rh-positive RBC’s. 4. If the supply of the appropriate Rh type has been exhausted, RBC’s of the other type should be used.

Rhogam®should be given within 48 hours of giving Rh positive blood to an Rh negative woman of childbearing age. If large amounts of Rh positive blood has been given red cell exchange may be necessary. If no uncrossmatched blood is available, type O RBC’s of the appropriate Rh type that is being held for another patient may be used in life-threatening emergency. The Bloodworks Northwest must be informed immediately that this has occurred so that these units can be replaced. A signed justification is needed for all use of uncrossmatched blood.