Study Calls Safety of Some Trauma Blood Transfusions into Question
New research by a University of Rochester Medicine team suggests that a certain type of blood transfusion is not nearly as safe as the medical establishment believes.
Patients undergoing transfusions in trauma situations or under what’s known as massive transfusion protocols often receive Group O blood with antibodies that may not match their own, at least as an emergency measure when their blood type is unknown. Doctors and researchers have considered that safe. But in a letter published this month in JAMA Surgery, URochester Medicine Department of Pathology and Laboratory Medicine faculty member Neil Blumberg, MD, and his colleagues from the Department of Surgery reported an association between large-scale non-matching transfusions and increased mortality.
Blumberg and his team looked at the outcomes for 403 patients who underwent massive transfusion protocol from 2008 to 2020. Patients receiving mismatched antigens—referred to as an ABO mismatch or an ABO non-identical transfusion—had higher mortality rates than patients who received similar amounts of ABO-identical blood. Among patients who received 6 to 15 transfusions, mortality rates were approximately twice as high when ABO-mismatched blood was used.
“These findings may be controversial because they contradict longstanding dogma, but there was never any data underpinning that dogma,” Blumberg said. “And it turns out it was wrong.”
To Blumberg, the findings are a call to action for work on a solution.
“To be clear, transfusions are often life-saving and necessary, and the benefits of going forward in a trauma situation may easily outweigh concerns about non-matching ABO antigens,” Blumberg said. “However, our research suggests the need to develop a truly universal donor—Group O blood with the A and B antibodies reduced or removed—to improve safety and outcomes. Currently, the ways of doing that are not widely available or entirely practical, but we believe our research underscores the need to work on this technology.”
The new findings build on decades of research into the risk of blood transfusion with mismatched antigens. Blumberg said the medical field has been slow to respond to the findings, but teams at URochester Medicine are well ahead of the international curve in taking account of the research.
“We stopped using ABO mismatched platelets about 35 years ago for hematology and oncology patients and—as the research progressed—for all transfusion recipients, including surgical patients, in 2005,” Blumberg said. “These trauma or massive transfusion patients are really the last group to look at, and even though there isn’t a clear fix right now, we believe it’s something doctors should be aware of and, when possible, address by making the determination of a patient’s ABO type a priority and administering ABO-identical blood components.”
Additional URochester Medicine authors were Kelly Henrichs, MS; Debra Masel, BS; Michael Vella, MD; Mark Gestring, MD; Amanda Lippa, BS, Phuong-Lan Nguyen, MD; Akua Asante, MD; Majed Refaai, MD; and Christine Cahill RN, now of the Mayo Clinic, Florida.
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