- Transfusing an ABO-incompatible RBC unit can cause a potentially fatal hemolytic transfusion reaction. The current whole blood products provided by ASBP to military operations are: NBB-LTOWB and Type A Whole Blood (NBB-TSWB).
- Determination of a recipient’s blood type must be done by directly testing their RBCs and plasma.
- Positive recipient identification must be completed prior to any TSWB transfusion.
- Do not rely on a potential recipient’s dog tags, uniform badges, tattoos, proclamations, or any other external markings for recipient ABO type.
- Manual saline tube test or an automated analyzer that performs both a forward and reverse test must be used to determine the recipient’s blood type prior to transfusion of NBB-TSWB. If the Role 3 is not able to support manual saline tube or automated analyzer ABO testing, the facility will not provide NBB-TSWB (Type A Whole Blood) for transfusion.
  - To increase patient safety, the Role 3 should perform blood type determination on a second independently collected patient sample before issuing NBB-TSWB.
  - There may be rare instances where patients possess an uncommon type A subgroup (e.g., A2). A small subset of these patients (1-8%) may produce antibodies to donor type A whole blood (e.g., anti-A1). Performing both forward and reverse blood typing is important in detecting these subgroups as the Role 3 blood banks do not have Type A subgroup identification capabilities. If a discrepancy between the forward and reverse blood type is observed, patients should receive LTOWB (NBB-LTOWB or WBB-LTOWB) or appropriate component therapy using universally compatible products.
- Type A patients are the only patients that can receive Type A NBB-TSWB.
- In situations where the recipient's blood type cannot be reliably determined (i.e., discrepancy between forward type and reverse type during testing), LTOWB or appropriate component therapy using universally compatible products including type O RBCs, type A plasma or Type AB plasma should be used instead.
- NBB-LTOWB can be given to all recipients, no matter the blood type.