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I never understood why each emergency room couldn't have a special blood-ready fridge with all blood types (i.e. A, B, AB, O +/-). They always have to call down to a blood bank to get type-specific blood. That always took minutes, and sometimes required them to blow more 0-NEG blood before the type-specific blood arrived.

Considering the following two points,

  1. 0-NEG blood is scarce.
  2. It takes roughly the same amount of time overall to queue up a small amount of type-specific blood in each ER.

Why not have a small fridge capable of holding blood in each ER? You replenish it as necessary. The time required to transport the blood is roughly the same in either setup.

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  • 1
    Are you asking specifically about the TV show ER? Or Real world Emergency Rooms? And I'm sure the answer is either going to be Because Real World ERs are like that or because we need to ramp up the drama/tension/suspense factor
    – cde
    Feb 1, 2016 at 6:26
  • Yes, the television show ER. I guess perhaps this question delves into the real world a little bit. However, the problem surfaces in the show thoroughly, and I'm looking for an answer that makes sense. In the show, to me, it doesn't ever make sense.
    – user11077
    Feb 1, 2016 at 6:40

1 Answer 1

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As a quick general world answer, some do, some don't, and blood transfusions aren't a quick "Just match blood type" procedure. Tests should be run, and only critical emergency situations merit unmatched blood transfusions. If you can't wait the few minutes for testing and transportation, the trauma victim is in severe enough condition to use the emergency O blood. Otherwise, it's not an emergency.

From The University of Michigan hospital blood bank rule book:

If blood is not currently available, the technologist can then determine the extent to which compatibility testing can be performed. As the amount of compatibility testing decreases, the possible risk of transfusing incompatible blood increases. Depending on the availability of a specimen and current status of testing blood may be released as

  • Uncrossmatched red blood cells
  • Type specific blood
  • Testing in process but antibody screen, crossmatch or antibody identification incomplete; antigen negative blood unavailable

Emergency Release Documentation
The Transfusion Record Form of emergency released units will contain the caution that the blood is being released on an emergency basis. The physician authorizing the emergency release must sign the Emergency Request section of the Blood Bank Requisition Form and return it to the Blood Bank. Blood specimens and requisitions must be appropriately labeled. Many hemolytic transfusion reactions have occurred under emergency conditions when routine patient identification procedures are ignored or circumvented. The Blood Bank will complete testing and notify the physician of the results of testing. Temperature monitors are attached to assist staff in determining if blood has been properly stored. The beads in the R & D indicator will have moved from the rounded end of the indicator if the blood has not been maintained below 10 C.

Related to the O Blood bags:

Group O Red Blood Cells are issued when a blood sample cannot be supplied, and/or the patient's blood is not available in the Blood Bank for typing. A blood sample should be drawn for typing and crossmatching before transfusion is initiated.

A Related Study:

Patients receiving uncross matched [Red Blood Cells] in the [Emergency Department] are more than three times more likely to receive early [Massive Transfusions] of RBCs. Additionally, patients transfused with ED RBCs are more likely to receive 6 units or more of plasma and two or more apheresis PLT transfusions. Given these findings, ED transfusion of uncrossmatched RBCs should be considered a potential trigger for activation of an institution's MT protocol.
-© 2010 American Association of Blood Banks.

Again:

DOING IT QUICKLY BUT SAFELY: PROVISION OF UNCROSSMATCHED RBCS AND PLASMA
Trauma patients often receive uncrossmatched group O RBCs before any compatibility testing can be completed. ... When issuing uncrossmatched, type-specific units for transfusion, the potential for acute ABO-incompatible hemolytic transfusion reaction due to a mislabeled speci- men for blood typing is a major concern,

Of course, commercial medical equipment manufacturers step up:

Emergency Department: Store blood where you need it most
The emergency department is one of the busiest places in the hospital. In such a fast paced environment, you need a system that can respond as quickly as you do. BloodSafe® makes blood available immediately where you need it — from secure, “smart refrigerators” located in or near high-need areas like surgical, trauma or emergency.

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  • Very good answer. With respect to the last part (the BloodSafe product), I think the question becomes "why did it take so long?" This is a fairly intuitive need and a fairly intuitive idea. For the other part of your answer, I will have to look up the terminology.
    – user11077
    Feb 1, 2016 at 7:17
  • ...From the excerpts you posted, it almost sounds like they mix a sample of the patient's blood with a sample from the prospective bag of blood that they will be shipping; basically a real-time compatibility test. But if that's not the case, then they only need to test the patient's blood. In that case, the question becomes "why haven't they invented an ultra-fast blood tester that each ER can have, in addition to a BloodSafe-like product?" You test the blood in the ER, pull some blood out of the ER fridge, save O-NEG blood, and possibly save a life in situations where O-NEG is exhausted.
    – user11077
    Feb 1, 2016 at 7:18
  • Because en.wikipedia.org/wiki/Acute_hemolytic_transfusion_reaction In a true emergency, they will risk it. It may save the patient, or do worse. Most situations can be handled by the emergency O bags. Hospitals are supplied for higher than normal trauma events. It's only the freak multi-people accidents that cause supply issues, train/bus/multicar crashes.
    – cde
    Feb 1, 2016 at 7:33
  • As for an ultra fast tester? Well, medical technology is heading towards that, but there are practical limits. Blood Typing requires the patient's blood to be tested against actual blood anti-bodies. Same for Rh Typing. They have to check for clumping/clotting. Current tech doesn't have a way around that. From sciencedaily.com/releases/2010/06/100602121200.htm you know its being worked on, but at the moment it doesn't exist. Technology takes time, money, effort. Consider, we only found out about blood types in 1901. And Germ Theory. Transfusions and surgery are relatively new still.
    – cde
    Feb 1, 2016 at 7:40

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