In the ED, the administration of type O blood or type-specific incompletely crossmatched blood may be lifesaving; however, it carries the risk of severe, life-threatening transfusion reactions. Massive, uncontrolled hemorrhage from any cause may necessitate transfusion with uncrossmatched type O blood. Its use is limited to the early resuscitative phase of patients with shock from exsanguinating hemorrhage and insufficient response to infused crystalloid solutions. Patients with trauma, massive GI bleeding, ruptured aortic aneurysm, or unexpected intraoperative hemorrhage may be candidates to receive emergency transfusions. Before any transfusions are given, baseline laboratory studies should be done, including blood for typing and crossmatching. Current practice limits the use of uncrossmatched type O blood to the initial resuscitation of patients with massive hemorrhage. Type-specific blood often can be obtained from the blood bank in 10 to 15 min after the sample is received and will avoid the majority of transfusion reactions. Fully crossmatched blood typically can be obtained in 30 to 60 min. Most hospitals use Rh-negative blood when it has not been fully crossmatched. PRBCs are the only blood product that can be given for emergency transfusion. Plasma products contain too many antibodies and should not have a role in the early phase of treatment of massive hemorrhage. As soon as type-specific crossmatched PRBCs are available, they should be given. Subsequent crossmatching will become more difficult as increasing amounts of uncrossmatched blood are transfused.
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