Transfusion of Uncrossmatched Group O Erythrocyte-containing Products Does Not Interfere with Most ABO Typings
Mark H. Yazer, M.D.; Philip C. Spinella, M.D.; Leilani Doyle, M.D.; Richard M. Kaufman, M.D.; Robyn Dunn, B.S.; et alJohn R. Hess, M.D.; Luiz Amorim Filho, M.D.; Magali Fontaine, M.D.; Birgit Gathof, M.D.; Bryon Jackson, M.D.; Michael F. Murphy, M.D.; Jeremiah Pasion, M.D.; Jay S. Raval, M.D.; Kristin Rosinski, M.L.T.; Jansen Seheult, M.D.; Andrew W. Shih, M.D.; Jason Sperry, M.D.; Julie Staves, B.Sc. (Hons); Erin E. Tuott, B.S.; Alyssa Ziman, M.D.; Darrell J. Triulzi, M.D.; Appendix. Members of the Biomedical Excellence for Safer Transfusion Collaborative
 Author Notes
From Vitalant, Pittsburgh, Pennsylvania (M.H.Y., D.J.T.); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (M.H.Y., D.J.T.); the Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, St Louis, Missouri (P.C.S.); the Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada (L.D.); Canadian Field Hospital, Canadian Armed Forces, Ottawa, Ontario, Canada (L.D.); the Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts (R.M.K.); the Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California (R.D., A.Z.); the Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington (J.R.H., E.E.T.); Hemorio, Rio de Janeiro, Brazil (L.A.F.); the Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland (M.F., J.P.); the Institute of Transfusion Medicine, University of Cologne, University Hospital, Cologne, Germany (B.G.); the Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (B.J.); National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, United Kingdom (J. Staves); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina (J.S.R.); the Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada (K.R., A.W.S.); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (J. Seheult); the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.W.S.); and the Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (J. Sperry). Current affiliation: Department of Pathology, University of New Mexico, Albuquerque, New Mexico (J.S.R.).
Submitted for publication April 24, 2019. Accepted for publication October 25, 2019.
*Members of the Biomedical Excellence for Safer Transfusion Collaborative are listed in the appendix.
Correspondence: Address correspondence to Dr. Yazer: Vitalant, 3636 Boulevard of the Allies, Pittsburgh, Pennsylvania 15143. myazer@itxm.org. 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.
Anesthesiology Newly Published on November 26, 2019. doi:https://doi.org/10.1097/ALN.0000000000003069

Abstract
Editor’s Perspective:

What We Already Know about This Topic:

Uncrossmatched erythrocyte units that are provided to a massively bleeding patient whose ABO group is unknown must be type O to ensure compatibility. The effect of transfusing type O units on the ability to subsequently determine the patient’s ABO group is not known.

What This Article Tells Us That Is New:

ABO typing in 665 of 695 (95.7%) non–group O recipients could be accurately determined on the first type and screen sample obtained by the blood bank after the transfusion of uncrossmatched type O erythrocyte-containing products.

Background: Group O erythrocytes and/or whole blood are used for urgent transfusions in patients of unknown blood type. This study investigated the impact of transfusing increasing numbers of uncrossmatched type O products on the recipient’s first in-hospital ABO type.

Methods: This was a retrospective cohort study. Results of the first ABO type obtained in adult, non–type O recipients (i.e., types A, B, AB) after receiving at least one unit of uncrossmatched type O erythrocyte-containing product(s) for any bleeding etiology were analyzed along with the number of uncrossmatched type O erythrocyte-containing products administered in the prehospital and/or in hospital setting before the first type and screen sample was drawn.

Results: There were 10 institutions that contributed a total of 695 patient records. Among patients who received up to 10 uncrossmatched type O erythrocyte-containing products, the median A antigen agglutination strength in A and AB individuals on forward typing (i.e., testing the recipient’s erythrocytes for A and/or B antigens) was the maximum (4+), whereas the median B antigen agglutination strength among B and AB recipients of up to 10 units was 3 to 4+. The median agglutination strength on the reverse type (i.e., testing the recipient’s plasma for corresponding anti-A and -B antibodies) was very strong, between 3 and 4+, for recipients of up to 10 units of uncrossmatched erythrocyte-containing products. Overall, the ABO type of 665 of 695 (95.7%; 95% CI, 93.9 to 97.0%) of these patients could be accurately determined on the first type and screen sample obtained after transfusion of uncrossmatched type O erythrocyte-containing products.

Conclusions: The transfusion of smaller quantities of uncrossmatched type O erythrocyte-containing products, in particular up to 10 units, does not usually interfere with determining the recipient’s ABO type. The early collection of a type and screen sample is important.