CME COURSE: TYPE O NEGATIVE RED BLOOD CELL UTILIZATION: PRESERVING THIS RARE AND LIFESAVING RESOURCE

Type O negative blood – every hospital wants a supply on its shelves. But with a prevalence of only seven percent within the population, this valuable resource must be managed with care. Dr. Mair will discuss ways to best utilize lifesaving type O negative red blood cells.


TARGET AUDIENCE / PREREQUISITES

This activity has been designed for general, specialty and subspecialty physicians who prescribe blood products and for hospital transfusion service Medical Directors. There are no participant prerequisites for this activity.

CME CREDITS: 1.0 AMA PRA Category 1 Credit(s)TM

CONTINUING CERTIFICATION CATEGORY: Medical Knowledge

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LEARNING OBJECTIVES
At the conclusion of this activity, participants should be able to:

  1. Identify O RhD– patients who are at lower risk for making an anti-D antibody after receiving O RhD+ red cells
  2. Describe ways to preserve the supply of O RhD- red cells for patients who need them
  3. Apply knowledge of AABB standards to providing RhD+ cellular products to RhD– patients

LEARNING TASKS
To receive CME credit for this activity, participants must:

  1. Acknowledge their review of activity prerequisites, objectives, disclosures, methods of physician participation and statements.
  2. Review the presentation "Type O Negative Red Blood Cell Utilization: Preserving this Rare and Lifesaving Resource" or read the PowerPoint slides and accompanying notes available as a printable Adobe Reader® file.
  3. Take the online Post-Test.
  4. Complete the online Activity Evaluation.
  5. Print the certificate awarding 1.0 AMA PRA Category 1 credit(s)TM through the SUCCESSTM program.

FACULTY
David C. Mair, M.D.
Chief Medical Officer
West Blood Services Division of the American Red Cross
St. Paul, MN

ACTIVITY PLANNER
Liz Marcus
Director, Hospital Sales and Marketing
Biomedical Services, American Red Cross
Washington, DC

LEARNING REFERENCES

  1. Issitt PD, Anstee DJ. Applied Blood Group Serology. Durham, NC: Montgomery Scientific Publications, 1998.
  2. Riley W, Schwei M, McCullough J. The United States' potential blood donor pool: estimating the prevalence of donor-exclusion factors on the pool of potential donors. Transfusion 2007;47:1180-8.
  3. Erickson ML, Champion MH, Klein R, Ross RL, Neal ZM, Snyder EL. Management of blood shortages in a tertiary care academic medical center: the Yale-New Haven Hospital frozen blood reserve. Transfusion 2008; 48:2252-63.
  4. Harmening D, ed. Modern Blood Banking And Transfusion Practices. 4th ed. Philadelphia, PA: FA Davis Co., 1997.
  5. http://www.transfusionguidelines.org.uk/docs/pdfs/nbtc_bbt_o_neg_red_cells_recs_09_04.pdf
  6. Spence RK, Jeter EK, Mintz PD. "Transfusion in Surgery and Trauma" in Mintz PD, ed. Transfusion Therapy: Clinical Principles and Practice. Bethesda, MD: AABB Press, 1999.
  7. http://www.cbbsweb.org/enf/2003/rhneg_short.html
  8. http://www.cbbsweb.org/enf/2001/onegshortage.html
  9. Bracey A, et al. Guidelines for Massive Transfusion. Bethesda, MD: AABB Press, 2005.
  10. Yuan S, Ziman A, Anthony MA, Tsukahara E, Hopkins C, Lu Q, Goldfinger D. How do we provide blood products to trauma patients? Transfusion 2009;49:1045-9.
  11. http://www.cbbsweb.org/enf/2004/urgenttx_abo_switch.html
  12. Como JJ, Dutton RP, Scalea TM, Edelman BB, Hess JR. Blood transfusion rates in the care of acute trauma. Transfusion 2004;44:809–13.
  13. Murthi SB, Stansbury LG, Hess JR. Blood and coagulation support in trauma. Blood Rev 2009;23:149–55.
  14. Pollack W, Ascari WQ, Crispen JF, O'Connor RR, Ho TY. Studies on Rh prophylaxis. II. Rh immune prophylaxis after transfusion with Rh-positive blood. Transfusion 1971;11:340-4.
  15. Urbaniak SJ, Robertson AE. A successful program of immunizing Rh-negative male volunteers for anti-D production using frozen/thawed blood. Transfusion 1981;21:64-9.
  16. Lozano M, Cid J. The clinical implications of platelet transfusions associated with ABO or Rh(D) incompatibility. Transfus Med Rev 2003;17:57-68.
  17. Mollison PL, Engelfriet CP, Contreras M. Blood transfusion in clinical medicine. Oxford, UK: Blackwell Scientific Publishers, 1993.
  18. Boctor FN, Ali NM, Mohandas K, Uehlinger J. Absence of D– alloimmunization in AIDS patients receiving D-mismatched RBCs. Transfusion 2003;43:173-6.
  19. Ramsey G, Hahn LF, Cornell FW, Boczkowski DJ, Staschak S, Clark R, Hardesty RL, Griffith BP, Starzl TE. Low rate of Rhesus immunization from Rh-incompatible blood transfusions during liver and heart transplant surgery. Transplantation 1989;47:993-5.
  20. Casanueva M, Valdes MD, Ribera MC. Lack of alloimmunization to D antigen in D-negative immunosuppressed liver transplant recipients. Transfusion 1994;34:570-2.
  21. Giannoudis PV. Current concepts of the inflammatory response after major trauma: an update. Injury 2003;34:397-404.
  22. Schwab CW, Civil I, Shayne JP. Saline-expanded group O uncrossmatched packed red blood cells as an initial resuscitation fluid in severe shock. Ann Emerg Med 1986;15:1282-7.
  23. Lefebre J, McLellan BA, Coovadia AS. Seven years' experience with group O unmatched packed red blood cells in a regional trauma unit. Ann Emerg Med 1987;60:1344-9.
  24. Schmidt PJ, Leparc GF, Samia CT. Use of Rh positive blood in emergency situations. Surg Gynecol Obstet 1988;167:229-33.
  25. Unkle D, Smejkal R, Snyder R, Lessig M, Ross SE. Blood antibodies and uncrossmatched type O blood. Heart Lung 1991;20:284-6.
  26. Dutton RP, Shih D, Edelman BB, Hess J, Scalea TM. Safety of uncrossmatched type-O red cells for resuscitation from hemorrhagic shock. J Trauma 2005;59:1445-9.
  27. Yazer MH, Triulzi DJ. Detection of anti-D in D– recipients transfused with D– red blood cells. Transfusion 2007;47:2197–201.
  28. Frohn C, Dümbgen L, Brand JM, Görg S, Luhm J, Kirchner H. Probability of anti-D development in D– patients receiving D+ RBCs. Transfusion 2003;43:893-8.
  29. Gonzalez-Porras JR, Graciani IF, Perez-Simon JA, Martin-Sanchez J, Encinas C, Conde MP, Nieto MJ, Corral M. Prospective evaluation of a transfusion policy of D+ red blood cells into D– patients. Transfusion 2008;48:1318-24.
  30. Ayache S. Herman JH. Prevention of D sensitization after mismatched transfusion of blood components: toward optimal use of RhIG. Transfusion 2008;48:1990-9.
  31. Brecher ME, ed. Collected Questions and Answers. 6th ed. Bethesda, MD: AABB Press, 2000.
  32. Karp JK, Ness PM. Acute renal failure with hemolysis in a D– mismatched transfusion recipient treated with RhIG. Transfusion 2009:49:1269-70.
  33. AABB. Standards for blood banks and transfusion services. 26th ed. Bethesda MD: AABB Press, 2009.
  34. Shaz BH, Dente CJ, Harris RS, MacLeod JB, Hillyer CD. Transfusion management of trauma patients. Anesth Analg 2009;108:1760-8.
  35. Reed. W et al. Transfusion-Associated Microchimerism: A new compilation of Blood Transfusions in severely Injured Patients.Seminars in Hematology, 2007, Vol 44, #1, 24-31
  36. Goodell PP, Uhl L, Mohammed M Powers AA: Risk of hemolytic transfusion reactions following emergency-release RBC transfusion. Am J Clin Pathol 2010; 134:202-6
  37. Tchakarov A, Hobbs R, Bai Y Transfusion of D+ red blood cells to D-individuals in trauma situations. Immunohematology 30(4): 149-52, 2014
  38. Meyer E & Uhl L A case for stocking O D + red blood cells in emergency room trauma bays. Transfusion 2015; 55 (4): 791-5
  39. Boisen ML, Collins RA, Yazer MH, Waters JH. Pretransfusion Testing and Transfusion of Uncrossmatched Erythrocytes. Anesthesiology 122(1):191-5, January 2015
  40. Cid J,Ortin , Elies E et al. Absence of anti-D alloimmunization in hematologic patients after RhD-incompatible platelet transfusions. Transfusion 2002; 42: 173-6
  41. Fung MK, Grossman BJ, Hillyer CD, Westhoff CM (Editors) AABB Technical Manual, 18th Edition 2015
  42. Shaz BH et al Transfusion management of trauma patients. Anesth Analg 2009; 108: 1760-8
  43. College of American Pathologists Transfusion Medicine Accreditation Checklists -- Northfield IL 2017 Edition
  44. Callum JL, Waters JH, Shaz BH, Sloan SR, Murphy MF. The AABB recommendations for the Choosing Wisely campaign of the American Board of Internal Medicine. Transfusion 2014 54(9):2344-52

DISCLOSURES
Dr Mair has indicated that he has no relevant financial relationships with commercial interests to disclose. No commercial support was received for this activity.

DISCLAIMER
The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of the American Red Cross Biomedical Services. Information herein is presented for educational purposes only and not to endorse off-label use. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings.

ACCREDITATION STATEMENT
The American Red Cross Biomedical Services (ARCBS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. This activity meets the American Board of Pathology (ABP) Continuing Certification (CC) for Self-Assessment Modules (SAMs).

DESIGNATION STATEMENT
The American Red Cross Biomedical Services designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™; physicians should only claim credit commensurate with the extent of their participation in the activity.

DISCLOSURE STATEMENT
All faculty participating in ARCBS continuing medical education programs are expected to disclose to learners whether they do or do not have any real or apparent conflict(s) of interest or other relationships related to the content of their presentation(s); faculty are also expected to disclose off-label and/or investigational uses of products under discussion.

RUPDATED COURSE RELEASE DATE: 03/08/2018

REVIEW DATE: 03/08/2018

EXPIRATION DATE: 03/07/2021

ESTIMATED TIME TO COMPLETE ACTIVITY: 1.0 hour(s)

Last modified: Tuesday, June 5, 2018, 04:03 PM