| No. | Error Case (Pre-Transfusion Testing Phase) |
|---|---|
| 1 | Mismatch between the patient's actual blood type and medical records |
| 2 | Unexpected antibody detected during antibody screening test |
| 3 | Transfusion ordered without performing pre-transfusion testing |
| 4 | ABO and Rh test results missing → Blood release denied by the blood bank |
| 5 | Barcode label on specimen does not match patient information |
| 6 | Specimen collected from a different patient with the same name |
| 7 | Using test results older than 72 hours for patients with repeated transfusions |
| 8 | Positive result in crossmatching → Blood product needs to be changed |
| 9 | Emergency transfusion attempted before completing crossmatch test |
| 10 | Pre-transfusion testing performed without checking past adverse transfusion history |
Emergency Transfusion Before Crossmatch Completion (Using O Rh-Negative Blood)
A 54-year-old female patient presents to the emergency department with abdominal trauma.
Bedside ultrasound suggests splenic rupture and intra-abdominal bleeding.
The patient is semi-conscious with unstable vital signs:
BP (78/52) mmHg, HR (134) bpm, RR (28) breaths/min, SpO₂ (90) percent
Doctor determines the need for emergency transfusion before crossmatch results are available.
The nurse initiates an Emergency Release Protocol with the blood bank, obtains verbal consent from the patient's guardian, and prepares for urgent transfusion using O Rh-negative PRBC.
Nurse (senior)
(Reviewing vital signs and reporting)
Blood pressure is (78/52) mmHg and heart rate is rising to (134) bpm.
The patient is semi-conscious and losing blood rapidly. We cannot delay transfusion.
Doctor Lee
We don’t have time to wait for crossmatching. Request 2 units of O Rh-negative PRBC and start the emergency transfusion protocol.
Explain the situation to the guardian and obtain verbal consent.
Nurse (senior)
(Calling the blood bank)
This is the ward calling for patient Sohyun Kim, ID 20230418.
Due to unstable vital signs and active hemorrhage, we are requesting emergency release of 2 units of O Rh-negative PRBC before crossmatching.
Doctor Lee has authorized this.
Blood Bank
Understood. We will release labeled O Rh-negative blood under the emergency protocol. It will be delivered shortly.
Nurse (senior)
(To guardian)
The patient is in a critical condition and we cannot wait for full compatibility testing.
We will proceed with transfusion using O Rh-negative blood, which is the safest universal blood type for emergencies.
There may be risks such as allergic or febrile reactions, but this is necessary to save her life.
Guardian
Please do whatever is needed. I agree to the transfusion — just help her quickly.
Nurse (senior)
(To new nurse)
Once the O Rh-negative PRBC units arrive, perform two-person verification of the blood product.
Ensure an 18G IV line is available, and check baseline vital signs.
During the first 15 minutes, monitor every 5 minutes for transfusion reactions: chills, fever, urticaria, dyspnea, back pain — be vigilant.
Nurse (senior)
(EMR documentation)
🗓 2025.04.08 17:20
- Patient presenting with internal bleeding from abdominal trauma
- Emergency transfusion initiated using O Rh-negative PRBC due to unstable vital signs prior to crossmatch completion
- Doctor’s verbal order obtained; guardian provided verbal consent
- Blood bank emergency release protocol used to obtain 2 units of PRBC
- Pre-transfusion vitals:
BP (78/52) mmHg, HR (134) bpm, Temp (36.5) °C, RR (28) breaths/min, SpO₂ (90) percent - Transfusion initiated; no adverse reactions noted so far; 1 unit currently in progress; vital signs monitored continuously
Nurse (senior)
(To new nurse)
In emergencies, transfusions can be administered before crossmatching when the patient is unstable.
O Rh-negative blood is used as the universal option.
Always ensure physician’s order, guardian’s consent, emergency release approval from the blood bank, and frequent monitoring during transfusion.
Document everything in detail.
Nurse (new)
This is my first time experiencing emergency transfusion. Thank you for guiding me step by step. It helped me understand the full process.
✅ Key Learning Points
| Situation | Unstable patient condition required transfusion before crossmatch completion |
| Nursing Actions | ① Confirmed vitals and reported to doctor ② Obtained guardian's verbal consent ③ Requested O Rh-negative blood via emergency release ④ Monitored for transfusion reactions ⑤ Documented process in detail |
| Documentation | Included emergency indication, authorization, consent, vital signs, and patient response |
| Clinical Reminder | In emergencies, O Rh-negative blood is the universal option. Always follow protocol: doctor order → guardian consent → blood bank request → monitor → document |
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