A CBBS e-Network member has inquired if any institution or accrediting agency (such as the AABB or CAP) has established formal definitions for the following transfusion scenarios:

• Emergency transfusion
• Urgent transfusion
• Routine transfusion

Emergency transfusion - A transfusion is needed within 1 hour -- Group O red cells or type specific uncrossmatched RBCs must be used, depending on the availability of a blood sample for testing. There is no time to obtain consent for transfusion.

Urgent transfusion - A transfusion is needed within 12 hours (such as for slow GI bleeders or trauma cases going to surgery), but the blood bank has at least one hour to perform crossmatches. There is time to obtain consent for transfusion, but not enough time to 'recruit' directed donors or for the patient to bank their own autologous donations.

Routine transfusion - A transfusion is needed within 3 days (3 days is the routine "life span" for a type and screen/cross specimen), but not within the next 12 hours. Includes transfusion of patients with chronic anemia and ideally, routine pre-op cases. There is time to obtain consent for transfusion, and there may be time to 'recruit' directed donors. However, there is not enough time for the patient to bank their own autologous donations (if the patient was medically fit to make such donations).

Routine (extended) - A transfusion is anticipated after 3 days. Includes pre-op surgical patients who have not been recently transfused or pregnant. There is time to obtain consent for transfusion and to fully comply with the Paul Gann Blood Safety Act.

EDITOR'S NOTE: The above definitions are being broadcast to the e-network for the sake of discussion.  Please send your comments, alternative definitions, etc., regarding the inquiring member's suggested definitions to the address below.

ADDENDA July 1, 2001

The following replies have been submitted by e-Network members to address the above question:

The first responder commented that at her hospital in Texas they use the following definitions (the Web Master has slightly edited these, but the intent is unchanged):

• Emergency/uncrossmatched (Group O or type specific) blood needed within 15 min.  Consent for transfusion obtained? - No;
• Emergency/crossmatched blood needed within 1 hour. Consent for transfusion obtained? - Yes 
• Urgent - blood needed to be transfused within 2 hours. Consent for transfusion obtained? - Yes 
• Routine - blood needed to be transfused within 4 - 6 hours. Consent for transfusion obtained? - Yes 
• Pre-admission - specimen is Typed and Screened (T&S) and kept in the laboratory for 7 days, and all consent for transfusion forms are completed. Immediate Spin Crossmatch is done at time of surgery for patients who do not have alloantibody problems. [The Web Master assumes that if a patient has a positive antibody screen that the antibody will be identified, that the laboratory will inform the patient's physician, and that an appropriate number of units of blood will be crossmatched, so that if blood is needed, a mad search for compatible units will not have to occur at the last minute.] 

The responding member added to her comments that "The time limits would surely be hard to define since they would be somewhat hospital size-dependent. What is acceptable in a hospital of 1000 might be unacceptable in a hospital of 100. If we took 12 hours to get an Urgent ready, we'd all have to hunt for jobs elsewhere."

A second responder commented that "Of course there are no standard definitions" and then proceeded to make the following suggestions: "Routine" means non-urgent; "Emergency" means non-routine and "Urgent" means the blood is needed within 30 minutes. The responding member said that Dr Dennis Donohugh's definitions of 25 years ago when he was at the FDA were keyed to the amount of time available for compatibility testing.  "Desperate" implied that some oxygen transport capacity was needed within 15-20 minutes, "Urgent" indicated that transfusion was needed within 30-60 minutes and "Routine" or "Planned Transfusion" usually implied that more than 2 hr. was available for the testing. These were widely discussed at the time.  "Emergency" was not one of his categories; he thought it too vague.  Similarly, he was trying to offer defined terms in place of the all-purpose "STAT". The STAT and ASAP terms are widely used but ill-defined.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator