Emergency uncrossmatched transfusion effect on blood type alloantibodies

J Trauma Acute Care Surg. 2012 Jan;72(1):48-52; discussion 52-3. doi: 10.1097/TA.0b013e31823f0465.


Background: Trauma patients receive emergency transfusions of unmatched Type O Rh-negative (Rh-) blood until matched blood is available. We hypothesized that patients given uncrossmatched blood may develop alloantibodies, placing them at risk for hemolytic transfusion reactions (HTRs).

Methods: Data regarding alloantibody profiles and HTR occurrence were collected from the records of trauma patients at our university-based trauma center who received emergency uncrossmatched blood from July 2008 to August 2010.

Results: A total of 132 patients received 1,570 units of packed red blood cells. Mean injury severity score was 28 ± 1.3. Forty-five (34%) patients died: 27 on hospital day 1; the remaining 18 had no evidence of HTR before death. Four Rh- female patients received Rh+ fresh frozen plasma, but none received Rh+ packed red blood cells. Three Rh- male patients received both Rh+ packed red blood cells and fresh frozen plasma, and one received Rh+ fresh frozen plasma. One patient developed anti-Rh D antibodies. None experienced HTR. One female patient had HTR from reactivation of anamnestic JK antibodies. Thirteen (33%) of 39 patients met criteria for HTR based on urinalysis and 29 (40%) of 72 patients tested met criteria for HTR based on hemoglobin and bilirubin values. Only one patient had confirmed HTR.

Conclusion: High rates of injury recidivism in trauma patients increase the likelihood of multiple blood transfusions during their lifetime. Rh- patients who receive Rh+ blood are at risk of developing anti-Rh antibodies, putting them at risk for HTR. The conservation of Rh- blood for use in female patients may be detrimental to Rh- male patients. Laboratory diagnostic criteria for HTR are nonspecific in the trauma population and should be used with caution.

MeSH terms

  • Blood Group Incompatibility / epidemiology
  • Blood Group Incompatibility / etiology
  • Blood Group Incompatibility / immunology*
  • Emergency Treatment / adverse effects*
  • Female
  • Humans
  • Injury Severity Score
  • Isoantibodies / immunology*
  • Male
  • Retrospective Studies
  • Rh-Hr Blood-Group System / immunology
  • Sex Factors
  • Trauma Centers / statistics & numerical data
  • Wounds and Injuries / immunology
  • Wounds and Injuries / therapy


  • Isoantibodies
  • Rh-Hr Blood-Group System