Uncrossmatched Red Cell Concentrate Transfusion for Abdominal Injury with Hemorrhagic Shock

Yoshihiro Moriwaki, Noriyuki Suzuki and Mitsugi Sugiyama

Critical Care and Emergency Center, Yokohama City University Medical Center

Background and Objectives: In the management of abdominal trauma including liver, spleen, and mesentery with hemorrhagic shock, surgeons must decide whether to conduct emergency resuscitative celiotomy and emergency transfusion. We clarified the safety and problems concerning uncrossmatched red cell concentrate (UCM RCC), which involves risks including lethal ABO-incompatible transfusion. Methods: In the last 5 years, we studied the circumstances of surrounding UCM RCC transfusion and the prevention of ABO-incompatible transfusion in 33 patients undergoing emergency UCM RCC transfusion including type O and Rh+ (O+) UCM RCC transfusion. Results: We prepared 426 units of UCM RCC and transfused 338 units (C/T ratio 91%) in 54 cases in 33 patients. The foci of catastrophic bleeding were the liver in 13 cases, spleen in 8 cases, and mesentery in 17 cases. Before transfusion, patients presented systolic blood pressure of 62.5 mmHg, a pulse of 117/minute, shock index (pulse rate/systolic pressure) of 1.97, and a base excess of -12.7 mEq/l. Twenty patients presented conscious disorder worse than 30 on the Japan coma scale. Seven-day-survival was 48%. O+UCM RCC transfusion was conducted in 17 patients without blood typing test (BTT) and in 11 non-type-O. O+UCM RCC transfusion was conducted after only 1 BTT in 8 patients, and in 4 non-type-O. Uncomfirmed non-O group-specific UCM RCC transfusion was conducted after only 1 BTT in 15 patients. Although the total number of patients who underwent UCM RCC transfusion showed no change during the study, the number of patients who underwent uncomfirmed non-O group-specific UCM RCC transfusion decreased. There were no ABO-incompatible transfusion and incident reports concerning emergency transfusion. Conclusions: O+UCM RCC transfusion is safe in emergencies.

Key words
uncrossmatched-red cell concentrate transfusion, type O red cell concentrate transfusion, emergency transfusion, abdominal trauma with hemorrhagic shock, ABO-incompatible transfusion

Reprint requests
Yoshihiro Moriwaki Critical Care and Emergency Center, Yokohama City University Medical Center
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
July 23, 2008

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