Heterogeneity in approaches for switching from universal to patient abo type-specific blood components during massive hemorrhage an international survey and review of the literature

Matthew S. Karafin*, Joanne L. Becker, Mary Berg, Robert A. DeSimone, Nicole L. Draper, Jay Hudgins, Ryan A. Metcalf, Monica B. Pagano, Yara A. Park, Susan N. Rossmann, Joseph Schwartz, Rhona Souers, Lamont Thomas, Lynne Uhl, Glenn E. Ramsey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Context.-ABO mistransfusions are rare and potentially fatal events. Protocols are required by regulatory agencies to minimize this risk to patients, but how these are applied in the context of massive transfusion protocols (MTPs) is not specifically defined. Objective.-To evaluate the approaches used by transfusion services for switching from universally compatible to patient ABO type-specific blood components during massive hemorrhage. Design.-We added 1 supplemental multiple-choice question to address the study objective to the 2019 College of American Pathologists proficiency test J-survey (J-A 2019). We also reviewed the available literature regarding this topic. Results.-A total of 881 laboratories responded to the supplemental question. Approximately 80% (704 of 881) reported a policy for ABO-type switching during an MTP. Policies varied considerably between responding laboratories, but most (384 of 704, 55%) required 2 ABO types to match before switching from universal to recipientspecific blood components. Additional safety measures used in a minority of these protocols included reaction strength criteria (103 of 704, 15%), on-call medical director approval (41 0f 704, 5.8%), universal red cell unit number limits (12 of 704, 1.7%), or the presence of a mixed field (3 of 704, 0.4%). Conclusions.-This survey reveals that significant heterogeneity exists regarding the available approaches for ABO-type switching during an MTP. Specific expert guidance regarding this issue is very limited, and best practices have not yet been established or rigorously investigated.

Original languageEnglish (US)
Pages (from-to)1499-1504
Number of pages6
JournalArchives of Pathology and Laboratory Medicine
Volume145
Issue number12
DOIs
StatePublished - Dec 2021

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

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