Principle: | Procedure: | References:
Massive transfusion is defined as replacing a patient’s total blood volume (adult: equal to approximately 8 units of red blood cells) within a 24-hour period. This will usually occur in conjunction with emergency issue of blood. Refer to the “Emergency Issue, Request for Uncrossmatched Blood” protocol.
1 When possible, obtain a blood sample before the transfusions begin. This will allow for the proper identification of the patient’s blood type. If it is not possible to obtain the specimen before the transfusions begin, obtain the specimen as soon as possible before many units have been given.
2. Once the recipient’s blood type has been established, it is best to switch to that blood type for the subsequent transfusions to conserve the O Negative blood supply.
3. If the recipient is an Rh Negative female less than 50 years of age, Rh Negative, ABO compatible red blood cells must be issued throughout the emergency. If the blood supply dwindles before replenishment can occur from the blood supplier, contact the pathologist for guidance.
4. Rh Negative females over 50 years of age and Rh Negative males may be given Rh Positive red blood cells only with the approval of the pathologist. Rh Immune Globulin treatment may be indicated in these cases.
5. It is not necessary to retest any patient specimen within the 3 day outdate of the original specimen. The original specimen should be used for subsequent crossmatching until the specimen is exhausted.
6. If a new specimen is required for subsequent crossmatching and serologic problems are seen (e.g.; ABO discrepancies due to passive Anti-A,B received through the transfused blood) a pathologist should be consulted.
7. There is no established algorithm for platelet or plasma administration during a massive RBCs transfusion.
1. AABB Technical Manual. Current edition.
2. AABB Standards For Blood Banks and Transfusion Services. Current edition.
i. July 2002 M. Burger, S. Rodriguez
ii. June 2007 S. Rodriguez (Revised: I.;II.4.,7.)
September 2009 S. Hosch (no changes)
November 2010 B. Wiley (no changes)