Dr. Leorosa Lehman (attribution given by request) from Erie County Medical Center reports that their facility is struggling to limit use of uncrossmatched trauma blood. She has been asked by the transfusion committee to pose the following questions to our readers who work at TRAUMA CENTERS:

1. Do you have a policy capping the maximum units of uncrossmatched blood you would release without a sample?

2. If so, would you allow exceptions? Example: A patient is exsanguinating: would you continue to issue uncrossmatched units as requested by the OR until such time the patient no longer requires blood, and once patient has received 6 units of blood, would your center just continue to give Group O's (O-pos for males & non-reproductive age women)?

3. If not, how do you limit the number of units of uncrossmatched blood in trauma?

The following comments have been received.

ADDENDA Oct. 26, 2006

1. The Medical Director at a University Trauma Center in Southern California comments that they aggressively pursue an early sample from the OR by hand-delivering the blood to the ED and waiting for the ED staff to draw a crossmatch sample. He says that this doesn't always work out, as it may be difficult to draw a patient during initial critical care. He notes, "it is safer to continue transfusing uncrossmatched blood than to let a patient exsanguinate, so there is no way to safely cap the number of uncrossmatched units released in an emergency."

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

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