Blood Transfusion

In a hospital or hospital-like setting, standard blood banking procedures apply, with the use of carefully cross-matched blood components as needed by the clinical situation.

In some operational settings, standard blood banking procedures may not be applicable or available. In these cases, direct donor to victim transfusion can be life-saving.

• Try to use a donor with O negative blood ("Universal Donor") if available.  
  • Don't try to match, for example, a B+ victim to a B+ donor. While the accuracy of blood type records has improved, there is still a significant inaccuracy rate (as high as 5%) in the medical record laboratory reports, identification cards, and dog tags. 
  • If you try to match a B+ victim to a B+ donor (type-specific blood transfusion), you are twice taking a 5% risk of a mismatch. It is safer to take that risk only once. 
  • If the only available blood is Rh positive, it can be safely used for transfusing men, as Rh sensitization, should it occur, is usually not a big problem for men. 
  • For women of childbearing age, 80% are Rh positive and they won't have a problem receiving Rh positive blood. Those 20% who are Rh negative may become sensitized to the Rh factor if they receive a unit of Rh positive blood. That may be a reasonable risk if her life is saved as a consequence of the transfusion. However, Rhogam may be used, in very large doses (25-30, full-size, 300 microgram ampoules, IV, per unit of blood), to neutralize the Rh sensitizing effects of the Rh positive blood.
    
• Arrange IV tubing so that there is a large-bore needle at each end. 
  • This is facilitated by use of a 3-way stopcock. 
  • If this is not available, you can simply cut off the tubing at the end and insert it into the hub of a needle. 
  • Sterile petroleum jelly can provide a seal and the needle is held tightly to the IV tubing with adhesive tape.
    
• Position the donor about 3 feet higher than the victim. 
  • With the victim in a lower bunk, the donor would be in an upper bunk. 
  • With the victim on the floor or on the deck, the donor would be on a cot or packing crate.
    
• Insert the IV into the donor's vein and let the blood flow downhill through the tube until it reaches the other end. Clamp the tubing just long enough to insert the other end into the victim's IV or vein.
  
• Unclamp the tubing and allow time for about 1 unit (500 cc) of  blood to flow into the victim. 
  • The exact amount of time would depend on the caliber of the tubing and needle, length of the tubing, height of the donor above the victim and doubtless other factors. 
  • In practice, allow about 10 minutes, but be prepared to stop it earlier if the donor becomes light-headed or dizzy.
    
• Because fresh, whole blood has better oxygen-carrying capacity than banked units of packed RBCs, and it is prewarmed, and because it contains platelets, clotting factors and serum proteins, each unit has about twice the clinical impact of a unit of packed cells from the bank. If, based on your clinical experience, you believe a patient would benefit from two units of PRBCs from a blood bank, they will generally do well with a single unit of fresh, whole blood.
  
• After the patient is transferred to a definitive care facility, it will be easier for them to identify the true, native blood type (major and minor  blood groups) if they have a sample of blood taken from the patient prior to any transfusions. If time permits and the tactical situation allows for it, try to draw a single red-topped tube of the victim's blood prior to transfusion that you can send along with the MEDEVAC for use by blood banks further up the line.

This section is based on "Abnormal Pregnancy," in "Operational Obstetrics & Gynecology, 2nd Edition," Bureau of Medicine and Surgery, Department of the Navy, 2000.

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*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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