EMERGENCY UNCROSSMATCHED-RED CELL CONCENTRATE TRANSFUSION FOR MASSIVE GASTROINTESTINAL BLEEDING WITH HEMORRHAGIC SHOCK-PREVENTION OF ABO-INCOMPATIBLE TRANSFUSION-

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  • MORIWAKI Yoshihiro
    Critical Care and Emergency Center, Yokohama City University Medical Center
  • SUGIYAMA Mitsugi
    Critical Care and Emergency Center, Yokohama City University Medical Center
  • TOYODA Hiroshi
    Critical Care and Emergency Center, Yokohama City University Medical Center
  • KOSUGE Takayuki
    Critical Care and Emergency Center, Yokohama City University Medical Center
  • SUZUKI Noriyuki
    Critical Care and Emergency Center, Yokohama City University Medical Center

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  • 消化管出血ショック例に対する緊急未交差赤血球輸血の経験‐ＡＢＯ型不適合輸血の回避‐

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Abstract

Background : Uncrossmatched-red cell concentrate (UCM-RCC) can easily cause ABO-incompatible transfusion in the management of lethal massive bleeding with hemorrhagic shock. Methods : We experienced 15 patients with gastrointestinal hemorrhage who underwent UCM-RCC transfusion (17 series and 80 units). In our institution we perform UCM-RCC transfusion to patients who are in refractory hemorrhagic shock over after 2,000 ml of bolus infusion and who cannot wait the report of crossmatching. Results : The volumes of transfused UCM-RCC ranged from 2 to 10 units for a case with the mean of 5.3 units, and less than 6 units in 93 % of all cases. Type O UCM-RCC transfusion without blood typing test (BTT) was performed in 7 cases. Type O UCM-RCC transfusion after only 1 BTT was performed in 4 cases, and non-O group specific UCM-RCC transfusion after only 1 BTT was performed in 4 cases. The mean of the worst values of systolic pressure, pulse rate, shock index (pulse rate/systolic pressure), and base excess before UCM-RCC transfusion were 76.9 mmHg, 117.5/minutes, 1.69, and -9.61 mEq/l, respectively. Disturbance of consciousness was noted in 8 cases. Two cases were non survivors (13 %). No ABO-incompatible transfusion and no transfusion related complications occurred. Conclusions : Rapid type O UCM-RCC transfusion is useful and safe in emergency UCM-RCC transfusion for gastrointestinal bleeding. We should require less than 6 units of UCM-RCC as a first request in managing gastrointestinal bleeding.

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