A transfusion medicine physician in Brazil wonders if colleagues would share their opinions as to the medically necessity of continuing to perform crossmatches on RBC units for patients who have experienced massive transfusion of at least 8-10 RBCs in less than 24 hours, assuming the patient is receiving ABO identical or compatible RBC units, and their pre-transfusion blood sample shows a negative antibody screen. According to the AABB Standard 5.17.5 (23rd Edition - 2005), a transfusion service shall have a policy regarding compatibility testing when, within 24 hours, a patient has received an amount of blood approximating the total blood volume. The Standard in question does NOT specify that RBC units not be crossmatched after a certain number of units has been received by a patient.

The following comments have been received.

ADDENDA Aug. 7, 2006

1. A transfusion medicine physician in Los Angeles comments that he is aware of facilities that stop crossmatching RBC units (and routinely issue uncrossmatched RBCs) as soon as a patient has received 10 RBCs in less than 24 hours; they justify this practice by arguing that after a patient has received a massive RBC transfusion, most of their circulating blood has been diluted with transfused blood, and that any antibodies capable of causing a hemolytic reaction have also been diluted. However, in the opinion of the Los Angeles physician, even if 99% of a patient's circulating red cells have been replaced with transfused RBCs, the administration of ABO incompatible RBCs can still cause a significant reaction since massively transfused patients usually receive FFP and platelets which contain ABO antibodies. Thus, eliminating all crossmatching of RBCs (including the elimination of immediate spin and computer crossmatch testing) after a patient receives a massive RBC transfusion is probably not in the best interests of patient care.

2. Dr. Jochewed B Werch, Medical Director, Ben Taub Gen. Hospital in Houston, Texas (attribution used with permission) reports that their local protocol for massive transfusion states that crossmatching is NOT to be performed after the transfusion of 8-10 RBC'S within 24 hours for patients with a negative antibody screening test result. She acknowledges that according to AABB Standard: 5.17.5, every blood transfusion service needs to have a massive transfusion protocol which states the blood bank policies for massive transfusions.

Please submit comments to the e-Network Forum.

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

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator