Emergency Release Transfusion Practices Provide an Enduring Reminder of Festina Lente—to Make Haste Slowly

In this issue of the American Journal of Clinical Pathology, Whiteneck et al1 present a 30-month retrospective review of patients who received emergency release RBCs from electronically connected satellite refrigerators (ECSRs). This well-written study describes the team’s experiences at two hospitals, one of which is a level I trauma center, using ECSRs that require patient identification and information inputs. In addition, the importance of a coordinated practice workflow among the specialties of emergency medicine, trauma surgery, and transfusion medicine is emphasized and evidenced in the care of these patients. The data presented highlight several key points for consideration when dispensing remote emergency RBCs. Furthermore, this study documents the first reported fatal acute hemolytic transfusion reaction in the context of emergency release RBCs, a practice that is generally considered safe. The first key point of the manuscript is a sobering reminder that emergency release RBC transfusions, although generally considered safe, are not completely without risk of patient harm and may even be fatal. One is reminded that the extensive patient identification protocols that the transfusion medicine service employs are designed to substantially reduce the risk of RBC transfusion incompatibility and that emergency transfusion protocols deliberately circumvent the time required to establish a safe transfusion. An emergency release transfusion is a clinical judgment wherein clinicians decide that the benefit from an emergent blood transfusion outweighs its potential risks. In these scenarios, the transfusion is deemed necessary to sustain life and sufficiently emergent that the more routine turnaround of 1 to 2 hours necessary to collect, transport, and test a patient’s blood sample must be abbreviated.2