The impact of uncross-matched blood transfusion on the need for massive transfusion and mortality: analysis of 5,166 uncross-matched units.
BACKGROUND
The objective of this study was to analyze the outcomes associated with uncross-matched blood transfusion during trauma resuscitation. Our hypothesis was that uncross-matched blood transfusion is a predictor of the need for massive transfusion and mortality.


METHODS
All injured patients receiving packed red blood cell (PRBC) transfusion during a 6-year period ending December 2005 were identified from the blood bank database at a level I trauma center. Uncross-matched red blood cell (URBC) and cross-matched red blood cells, plasma and platelet utilization, and injury demographics were abstracted for each patient.


RESULTS
Of 25,599 trauma patients, 4,241 (16.6%) patients received 29,375 units of PRBC and 1,236 (29.1%) of the transfused patients received 5,166 units of URBC during their resuscitation. Patients requiring URBC had a higher mortality (39.6% vs. 11.9%, p < 0.001) and were more likely to require massive (> or = 10 PRBC during 12 hours) transfusion (29.3% vs. 1.8%, p < 0.001). There was a stepwise increase in mortality with increasing URBC transfusion. After adjusting for age, gender, mechanism, hypotension at admission, emergency department intubation, initial hemoglobin, Glasgow Coma Scale, Abbreviated Injury Scale, Injury Severity Score, and amount of blood products received; URBC remained an independent predictor of mortality (adjusted odds ratio 2.15; 95% confidence interval 1.58-2.94; p < 0.001) and massive transfusion (adjusted odds ratio, 11.87; 95% confidence interval, 8.43-16.7; p < 0.001). Patients receiving URBC also utilized more blood components (11.9 +/- 12.7 vs. 4.9 +/- 5.8 units of PRBC, p < 0.001; 5.1 +/- 8.9 vs. 2.0 +/- 4.8 units of plasma, p < 0.001; and 1.1 +/- 2.5 vs. 0.4 +/- 1.6 units of platelets, p < 0.001).


CONCLUSIONS
The requirement for uncross-matched blood during the acute resuscitation of trauma patients is an independent predictor of mortality and the need for massive transfusion. A URBC request during resuscitation should be considered by the blood bank as a potential trigger to prepare for massive transfusion.
Inaba
Kenji
K
Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, California 90033, USA. kinaba@surgery.usc.edu
Teixeira
Pedro G R
PG
Shulman
Ira
I
Nelson
Janice
J
Lee
John
J
Salim
A
A
Brown
Carlos
C
Demetriades
Demetrios
D
Rhee
Peter
P
D000017:ABO Blood-Group System; D015998:Abbreviated Injury Scale; D000046:Academic Medical Centers; D000328:Adult; D001787:Blood Group Incompatibility / Q000097:blood / Q000401:mortality*; D001788:Blood Grouping and Crossmatching; D003422:Critical Care / Q000379:methods; D017707:Erythrocyte Transfusion / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000097:blood / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood / Q000401:mortality / Q000628:therapy*; D010949:Plasma; D017713:Platelet Transfusion / Q000401:mortality*; D011379:Prognosis; D012151:Resuscitation; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D055815:Young Adult
D000017:ABO Blood-Group System