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.

TitleHeterogeneity in Approaches for Switching From Universal to Patient ABO Type-Specific Blood Components During Massive Hemorrhage: An International Survey and Review of the Literature.
Publication TypeJournal Article
Year of Publication2021
AuthorsKarafin MS, Becker JL, Berg M, DeSimone RA, Draper NL, Hudgins J, Metcalf RA, Pagano MB, Park YA, Rossmann SN, Schwartz J, Souers R, Thomas L, Uhl L, Ramsey GE
JournalArch Pathol Lab Med
Date Published2021 Mar 15
ISSN1543-2165
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) report 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 recipient-specific 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.

DOI10.5858/arpa.2020-0374-CP
Alternate JournalArch Pathol Lab Med
PubMed ID33720316
Related Faculty: 
Robert DeSimone, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
Surgical Pathology: (212) 746-2700