Department of Surgery, Division of Trauma/Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Transfusion. 2019 Aug;59(8):2532-2535. doi: 10.1111/trf.15405. Epub 2019 Jun 26.
A 45-year-old male presented in severe hypovolemic shock after a thoracoabdominal gunshot wound. The massive transfusion protocol (MTP) was activated and the patient was taken to the operating room. His major injuries included liver, small bowel, and right common iliac vein. Hemorrhage was stopped and a damage control laparotomy was completed. He received a total of 113 blood products. During his postoperative course he received a group B blood transfusion on Hospital Days 2 and 7 based on incorrect blood typing late in his massive transfusion and repeat testing on Day 4.
He succumbed to multiple organ failure on Day 8. MTPs are standard in most trauma centers during which universal donor red blood cells are initially used. As hemorrhage is controlled, the patient undergoes a complete type and cross according to blood banking protocols. These typing results are used to continue transfusions once the MTP is no longer needed. In contacting other blood banks servicing Level I trauma centers, the policy of when to switch from universal donor blood to crossmatched blood is variable.
Our case illustrates a potential blood typing problem that had a disastrous outcome. We identified changes in policy that will make MTPs safer.
一名 45 岁男性因胸腹枪击伤导致严重低血容量性休克。启动了大量输血方案（MTP），并将患者送往手术室。他的主要损伤包括肝、小肠和右髂总静脉。出血得到控制，完成了损伤控制性剖腹手术。他共接受了 113 个血制品。在术后期间，根据大量输血后期错误的血型鉴定和第 4 天的重复检测，他在住院第 2 天和第 7 天接受了 B 型血输血。
他在第 8 天因多器官衰竭而死亡。在大多数创伤中心，MTP 是标准操作，最初使用通用供体红细胞。随着出血得到控制，根据血库规程对患者进行全面的血型鉴定和交叉配血。一旦不再需要 MTP，就会根据这些血型鉴定结果继续输血。在联系服务于一级创伤中心的其他血库时，从通用供体血切换到交叉配血的策略因政策而异。
我们的病例说明了一个潜在的血型鉴定问题，其结果是灾难性的。我们确定了将使 MTP 更安全的政策变化。
