- Email: [email protected]
Operation of a group O blood bank
OPERATION' OF A GROUP 0 BLOOD BANK':' Urwn:;J<: D.
PAT'L'ON,
l\:I.D., PITTSBUHGH, PA.
(From the Pittsbm·_qh Hospital)
HE rhicf difficulty in maintaining a blood hank in a small hospital is keeping an adequate supply of fresh blood. Type spcritir transfusions require the usc of eig·ht different blood types, 0, .\. B, and AB, both Rh positive and Rh negative. If all these types are not stocked, the purpose of the bank is defeated in that blood is not available immediately. If all t~'pes are stocked there is a tremendous waste because blood must be used within three weeks. Small hospitals haw too few tram;fusions to keep the blood moving at a constant rate. <>ne answer to the problem is in the usc of gToup 0 blood for all patients. A group 0 blood hank is very simple. Only two types of blood are required, This ensures an adequate supply of blood <) Rh-positivc and 0 Rh-negative. without the danger of waste during periods of lessened demand. Opposition to the use of group 0 blood for patients of the other blood gToups is largely theoretical and is usually voiced hy those who have not used it. Published data stress the relative freedom from rcartions. The tcehnical faf•tors involved in the usc of group 0 blood are not complex. (!roup 0 blood rcotains Eo agg·lutinog·ens hut does eontain alpha and beta agglutinins as shown in Table I. These agxlutinins in the serum may clump the red blood cells whieh contain A or B agglutinogen if the titer of the agglutinin is sufficiently high. The donor's blood is usually sufficiently diluted by the large volume of cirrulating hlocd of the reeipient to reduce the titer of alpha and beta agglutinins to a harmless level. This was considered satisfactory until Witebsky brought out his speei:fir A and B substance which will neutralize the a and (3 agglutinins in vitro. A and B substance may be added to each bottle of 0 hlood or, if it is preferred, high titer ( 1 :32 or higher) 0 blood may be given only to 0 patien1s and low titer 0 blood reserved for A, B, and AB patic·nts.
T
TABLE
BLOOD GROUP
AGGL\TTJNOGEKS
AB
AGGLUTININS
a(J
0 A B
I
A B
{:!
AB
No cross-matching is necessary and is even misleading because the minor eross, patient's cells and donor's serum, will usually show clumping. Because of this, a safety factor is necessary to be doubly sure the donor's blood is group 0. Thi~: may be done by typing the serum with A and B cell suspensions (Table II) or by cross-matching with a ·'known 0'' blood. *Presented at a meeting of the Pittsburgh Obstett·ical and Gynecological Society, Nov. 8, 1948.
Am,
PA'l'TON
J.
Obst. & Gynec.
March, !950
In some sections of the country, the use of nonspecific group 0 blood for transfusion is feared. That this fear is largely theoretical and without practic·al basis, makes it none the less real. The author had used nonspecific group 0 blood to transfuse patients of all types in civilian practice and in the Army during the rerent war. Both of these experiences showed that no more reactions were encountered than with the use of type specific transfusions. Accordingly we established a group 0 blood bank at Pittsburgh Hospital on April 4, 1947. This is a general hospital of 225 beds. We had an average of seven to ten transfusions per month before establishment of the bank. This has risen to an average of 25.6 pm· month over the eighteen and one-hal£ months of the bank's operation. The load varies but we find that a supply of 10 pints of type 0 Rh-positive blood and 2 to 4 pints of type 0 Rh-negative blood is an adequate amount to keep in the bank. Blood is preserved in A C D solution (citric acid, sodium citrate, and dextrose) and is used up to 21 days after withdrawal. Occasionally a family will have trouble finding type 0 donors, especially if repeated transfusions are necessary. We have no quarrel with the use of type specific blood under such circumstances. Some of our physicians prefer to use type specific blood and we honor this desire if it does not complicate our routine. One of the virtues of a blood bank is that it simplifies the work of the laboratory and permits this work to be done at leisure after the transfusion and during the normal working hours of daylight. Most blood banks do not hesitate to use type 0 blood when they cannot obtain the 1are types and yet they hesitate to use it routinely. 'l'ABLE
II.
TYPING '' 0'' BLOOD
A serum ({3 agglutinin) plus 0 erythrocytes B serum (a agglutinin) plus 0 erythrocytes
= no agglutination = no agglutination
0 serum ( af3 agglutinins) plus A erythrocytes = agglutination 0 serum ( af3 agglutinins) plus B erythrocytes = agglutination
T ABLF: Ill. DONOR
BLOOD TRANSF'FSIONS, PITTSBURGH HOSPITAL
RECIPIENT
T01'AT,
0
A
131
0
B
::!8
0
AB
()
~
0
(Emergeney) 0
A B
B
AB
AB
A
Hi 11 2-!R
29 1 9 4~'' /d
------~- ---------~·---
*S, sev~n-_;, M. mocterate
81, slight
I'ER CENT REACTIONS* REACTIONS
38 1M lS 2M ()
0
5S 11M 381 381 0 lSI
l
3.0% 10.7% 0.0% 0.0%
7.7% 10.3% O.Oo/r
11.1 o/r
1 3.2%
J I~ j
(
l
f1I 10.3%
I
I
5.76%
8.0%
Volume ;cJ Number 3
OPERA'fiON OF A GROUP 0 BLOOD BANK
695
Our expcrienee is summarized in Table III. Reactions were graded as severe, moderate, or mild. Severe ( S) indicates a temperature rise of more than 101 o and/or a chill. Moderate (M) indicates temperature rise of less than 101 o F. Slight indicates very minor and inconsequential symptoms. Hyperpyrexia reactions were most frequent. Two cases of urticaria were recorded. The number of all reactions occurring when type 0 blood was used to transfuse patients of other types was less than when type specifie donors were used. The number of severe reactions in both groups was about equal and approximated 2 per cent although percentages in such a small group are not statistically significant. Only two reactions were potentially serious. Both were stopped after only a few cubic centimeters were given because of dyspnea and anginal pain. Recheck of the donor blood in one case showed that it had been erroneously reported as 0 whereas it actually was B. The recipient was type A. No cause was found for the second reaction. There were no reactions that persisted more than a few hours.
Summary and Conclusions Experience with the use of group 0 blood for all transfusions has proved practical in a 225-bed hospital over an eighteen-month period. Reactions are no more frequent nor more severe than when type specific blood is used. Waste is reduced to a minimum.
Bean, William B., Cogswell, Robert, Dexter, Morris, and Embick, James F.: Changes of the Skin in Pregnancy, Surg., Gynec. & Obst. 88: 73fl, lfl4fl.
Vascular
In an extremely interesting article the authors have analyzed the occurren~e of vasrulnr spiders and palmar erythema in 484 white and 759 Negro pregnant women. Vascular spiders were found in 66.6 per cent of the white women and 11.4 per cent of the Negroes. There was a marked increase in the incidence of vascular spiders as pregnancy progressed, a peak being observed just prior to delivery. There was rapid disappearance of these lesions during the postpartum period. The control group of 58 nonpregnant white women showed only a 12 per cent incidence of this phenomenon. The findings in Negro women differed chiefly in the low incidence of these spiders. The occurrence of this lt>sion was found to be definitely correlatt>d with the amount of skin pigmentation, thus, spiders were mort> frequent in light blondes than in brunettes. Palmar erythema was observed in 62.5 per cent of white women and in 35 per cent of Negro women. There was an increase in the incidence of palmar erythema during the progress of pregnancy similar to that seen with the vascular spiders, but not quite so marked. Palmar erythema was almost three times as common as vascular spiders in Negro women, \vhi!e there 'vas only a slight difference in the incidence of vascular spiders and palmar erythema in white women. The authors felt that the probable cause was the variation in skin pigmentation which was much less deep in the palms than in other areas of skin of Negro won1en.
PAT'L'ON,
l\:I.D., PITTSBUHGH, PA.
(From the Pittsbm·_qh Hospital)
HE rhicf difficulty in maintaining a blood hank in a small hospital is keeping an adequate supply of fresh blood. Type spcritir transfusions require the usc of eig·ht different blood types, 0, .\. B, and AB, both Rh positive and Rh negative. If all these types are not stocked, the purpose of the bank is defeated in that blood is not available immediately. If all t~'pes are stocked there is a tremendous waste because blood must be used within three weeks. Small hospitals haw too few tram;fusions to keep the blood moving at a constant rate. <>ne answer to the problem is in the usc of gToup 0 blood for all patients. A group 0 blood hank is very simple. Only two types of blood are required, This ensures an adequate supply of blood <) Rh-positivc and 0 Rh-negative. without the danger of waste during periods of lessened demand. Opposition to the use of group 0 blood for patients of the other blood gToups is largely theoretical and is usually voiced hy those who have not used it. Published data stress the relative freedom from rcartions. The tcehnical faf•tors involved in the usc of group 0 blood are not complex. (!roup 0 blood rcotains Eo agg·lutinog·ens hut does eontain alpha and beta agglutinins as shown in Table I. These agxlutinins in the serum may clump the red blood cells whieh contain A or B agglutinogen if the titer of the agglutinin is sufficiently high. The donor's blood is usually sufficiently diluted by the large volume of cirrulating hlocd of the reeipient to reduce the titer of alpha and beta agglutinins to a harmless level. This was considered satisfactory until Witebsky brought out his speei:fir A and B substance which will neutralize the a and (3 agglutinins in vitro. A and B substance may be added to each bottle of 0 hlood or, if it is preferred, high titer ( 1 :32 or higher) 0 blood may be given only to 0 patien1s and low titer 0 blood reserved for A, B, and AB patic·nts.
T
TABLE
BLOOD GROUP
AGGL\TTJNOGEKS
AB
AGGLUTININS
a(J
0 A B
I
A B
{:!
AB
No cross-matching is necessary and is even misleading because the minor eross, patient's cells and donor's serum, will usually show clumping. Because of this, a safety factor is necessary to be doubly sure the donor's blood is group 0. Thi~: may be done by typing the serum with A and B cell suspensions (Table II) or by cross-matching with a ·'known 0'' blood. *Presented at a meeting of the Pittsburgh Obstett·ical and Gynecological Society, Nov. 8, 1948.
Am,
PA'l'TON
J.
Obst. & Gynec.
March, !950
In some sections of the country, the use of nonspecific group 0 blood for transfusion is feared. That this fear is largely theoretical and without practic·al basis, makes it none the less real. The author had used nonspecific group 0 blood to transfuse patients of all types in civilian practice and in the Army during the rerent war. Both of these experiences showed that no more reactions were encountered than with the use of type specific transfusions. Accordingly we established a group 0 blood bank at Pittsburgh Hospital on April 4, 1947. This is a general hospital of 225 beds. We had an average of seven to ten transfusions per month before establishment of the bank. This has risen to an average of 25.6 pm· month over the eighteen and one-hal£ months of the bank's operation. The load varies but we find that a supply of 10 pints of type 0 Rh-positive blood and 2 to 4 pints of type 0 Rh-negative blood is an adequate amount to keep in the bank. Blood is preserved in A C D solution (citric acid, sodium citrate, and dextrose) and is used up to 21 days after withdrawal. Occasionally a family will have trouble finding type 0 donors, especially if repeated transfusions are necessary. We have no quarrel with the use of type specific blood under such circumstances. Some of our physicians prefer to use type specific blood and we honor this desire if it does not complicate our routine. One of the virtues of a blood bank is that it simplifies the work of the laboratory and permits this work to be done at leisure after the transfusion and during the normal working hours of daylight. Most blood banks do not hesitate to use type 0 blood when they cannot obtain the 1are types and yet they hesitate to use it routinely. 'l'ABLE
II.
TYPING '' 0'' BLOOD
A serum ({3 agglutinin) plus 0 erythrocytes B serum (a agglutinin) plus 0 erythrocytes
= no agglutination = no agglutination
0 serum ( af3 agglutinins) plus A erythrocytes = agglutination 0 serum ( af3 agglutinins) plus B erythrocytes = agglutination
T ABLF: Ill. DONOR
BLOOD TRANSF'FSIONS, PITTSBURGH HOSPITAL
RECIPIENT
T01'AT,
0
A
131
0
B
::!8
0
AB
()
~
0
(Emergeney) 0
A B
B
AB
AB
A
Hi 11 2-!R
29 1 9 4~'' /d
------~- ---------~·---
*S, sev~n-_;, M. mocterate
81, slight
I'ER CENT REACTIONS* REACTIONS
38 1M lS 2M ()
0
5S 11M 381 381 0 lSI
l
3.0% 10.7% 0.0% 0.0%
7.7% 10.3% O.Oo/r
11.1 o/r
1 3.2%
J I~ j
(
l
f1I 10.3%
I
I
5.76%
8.0%
Volume ;cJ Number 3
OPERA'fiON OF A GROUP 0 BLOOD BANK
695
Our expcrienee is summarized in Table III. Reactions were graded as severe, moderate, or mild. Severe ( S) indicates a temperature rise of more than 101 o and/or a chill. Moderate (M) indicates temperature rise of less than 101 o F. Slight indicates very minor and inconsequential symptoms. Hyperpyrexia reactions were most frequent. Two cases of urticaria were recorded. The number of all reactions occurring when type 0 blood was used to transfuse patients of other types was less than when type specifie donors were used. The number of severe reactions in both groups was about equal and approximated 2 per cent although percentages in such a small group are not statistically significant. Only two reactions were potentially serious. Both were stopped after only a few cubic centimeters were given because of dyspnea and anginal pain. Recheck of the donor blood in one case showed that it had been erroneously reported as 0 whereas it actually was B. The recipient was type A. No cause was found for the second reaction. There were no reactions that persisted more than a few hours.
Summary and Conclusions Experience with the use of group 0 blood for all transfusions has proved practical in a 225-bed hospital over an eighteen-month period. Reactions are no more frequent nor more severe than when type specific blood is used. Waste is reduced to a minimum.
Bean, William B., Cogswell, Robert, Dexter, Morris, and Embick, James F.: Changes of the Skin in Pregnancy, Surg., Gynec. & Obst. 88: 73fl, lfl4fl.
Vascular
In an extremely interesting article the authors have analyzed the occurren~e of vasrulnr spiders and palmar erythema in 484 white and 759 Negro pregnant women. Vascular spiders were found in 66.6 per cent of the white women and 11.4 per cent of the Negroes. There was a marked increase in the incidence of vascular spiders as pregnancy progressed, a peak being observed just prior to delivery. There was rapid disappearance of these lesions during the postpartum period. The control group of 58 nonpregnant white women showed only a 12 per cent incidence of this phenomenon. The findings in Negro women differed chiefly in the low incidence of these spiders. The occurrence of this lt>sion was found to be definitely correlatt>d with the amount of skin pigmentation, thus, spiders were mort> frequent in light blondes than in brunettes. Palmar erythema was observed in 62.5 per cent of white women and in 35 per cent of Negro women. There was an increase in the incidence of palmar erythema during the progress of pregnancy similar to that seen with the vascular spiders, but not quite so marked. Palmar erythema was almost three times as common as vascular spiders in Negro women, \vhi!e there 'vas only a slight difference in the incidence of vascular spiders and palmar erythema in white women. The authors felt that the probable cause was the variation in skin pigmentation which was much less deep in the palms than in other areas of skin of Negro won1en.