Is the famous blood donation scene in "Rampage" correct? (Part 1)

This is the 4746th article of Da Yi Xiao Hu

Introduction

The most popular TV series in China in 2023 is undoubtedly "Kuang Biao". The content about fighting against gangsters and evil in the film is very exciting, which is also the reason why the show can be popular, but some content seems not so perfect. Today we are going to talk about several scenes about blood donation in it. Are they correct?

Scene 1

In the 36th episode of the TV series, Gao Xiaochen, played by Wu Yuqing, was injured and entered the operating room. A female medical staff member rushed out of the operating room and told everyone: "The patient has lost too much blood and needs RH negative O type blood. But our blood bank does not have this blood type. Who among you has a blood type that matches his?" Everyone around shook their heads, and at this time, An Xin, played by Zhang Yi, raised his hand to indicate that his blood type matched that of An Xin. The female medical staff member said: "Come in with me to have a blood test."

Do people with RH negative blood type have to receive Rh negative blood?

In addition to the ABO blood group system, the second largest blood group system in humans is the Rh (D) blood group system. During their research, scientists accidentally discovered that the antigens expressed on the surface of rhesus monkey red blood cells are the same as those of human red blood cells. Therefore, they named it the D antigen and named it the Rh blood group system based on the rhesus monkey system. Rh (D) positive means that human blood red blood cells contain D antigen, while Rh (D) negative means that they do not contain D antigen. It is a relatively rare blood type and is often called panda blood. In clinical practice, if the patient needs a blood transfusion, in addition to the ABO blood type determination, we also need to perform Rh (D) blood type determination to avoid hemolysis.

Among the Han nationality and most ethnic groups in my country, the RH(D) negative population accounts for about 0.3%. In a certain situation, among non-relative people, the probability of two RH(D) negative people with O blood type appearing at the same time as in the drama is too small!

In June 2000, the National Health Commission of my country issued the "Technical Specifications for Clinical Blood Transfusion" in Article 10, which stipulates: "For patients with Rh(D) negative and other rare blood types, autologous blood transfusion, homologous blood transfusion or compatible blood transfusion should be used." The "Technical Specifications for Clinical Blood Transfusion" in Article 15 also stipulates: "When emergency blood transfusion is performed on patients in emergency rescue, Rh(D) examination can be excluded", which means that Rh(D) blood type can be excluded during emergency rescue, that is, there is no need to transfuse Rh(D) negative blood.

In addition, according to the law, in order to ensure the safety of blood transfusion, only medical institutions with blood collection and supply qualifications, such as blood centers or blood stations, can collect and supply blood according to law. After the blood is collected, it must go through the registration, testing, preparation and other processes before being sent to the hospital. It is a serious violation of the law for hospitals to collect and supply blood on their own. Of course, hospitals and blood stations usually have a certain amount of spare blood in case of emergency. Therefore, voluntary blood donors like An Xin are impossible to appear in real hospital emergency situations.

What is the general blood transfusion process like?

The procedure for completing a blood transfusion treatment includes several key steps, from applying for blood transfusion to post-transfusion evaluation, and each link is crucial.

1. Applying for blood transfusion is the first step of the whole procedure, which is mainly the responsibility of medical staff. The attending physician needs to strictly grasp the indications for blood transfusion according to the patient's condition, and explain to the patient or family members the possible adverse reactions of blood transfusion and the possibility of blood-borne diseases. After obtaining the consent of the patient or family members, both parties must sign and agree on the "Blood Transfusion Treatment Consent Form". For patients who are not aware of their own consciousness, if emergency blood transfusion is required, the relevant functional departments or supervisors of the hospital must be immediately reported to and filed for approval, and the relevant circumstances must be recorded in the medical records. The attending physician also needs to fill out the "Clinical Blood Transfusion Application Form" and be approved by the attending physician.

Nursing staff are required to take the "Clinical Blood Transfusion Application Form" and the labeled test tubes to conduct face-to-face verification with the patient to ensure that important information such as name, age, medical record number, department bed number, ward, blood type and diagnosis are accurate before blood samples can be collected. Subsequently, the nursing staff will send the collected blood sample together with the "Clinical Blood Transfusion Application Form" to the blood transfusion department (blood bank). After both parties carefully check each item, the department's blood transfusion application is completed.

2. Local blood stations (blood centers) should formulate plans for blood sources, blood collection, blood storage, blood testing, and blood supply based on local medical needs and in full compliance with relevant national laws and regulations, and put them into practice. The blood supplied must be strictly tested for quality to ensure that all indicators meet relevant national regulations.

3. When the hospital blood transfusion department (blood bank) receives blood from local blood stations or blood centers, it needs to immediately check the quality, quantity, packaging, blood bag closure, label filling, storage time, transportation method, etc. of the blood provided to confirm whether it complies with relevant national regulations. At the same time, it is also necessary to further check whether the blood supply meets the requirements of the "Clinical Blood Transfusion Application Form", such as composition (whole blood or which component blood), blood type, quantity, processing method (such as washing, freezing, concentration), etc.

Identification of donor and recipient blood types is another very important task undertaken by the hospital's blood transfusion department. Common blood type systems include the ABO blood type, Rh blood type and other blood type systems mentioned above, which need to be identified through positive and negative identification techniques. In order to prevent rare blood type mismatches between donors and recipients, a "cross-matching" experiment is also required: including direct cross-compatibility matching experiments (donor red blood cells + recipient serum) and indirect cross-compatibility matching experiments (recipient red blood cells + donor serum) to observe whether agglutination reactions will occur between the two, and fill out the cross-matching experiment report form truthfully.

Only after completing the above procedures can blood transfusion treatment be performed. The whole process is rigorous and meticulous, and each link is indispensable to ensure the safety of the patient and the treatment effect. We can only distribute blood to the department when all indicators of blood supply meet the requirements and all blood nuclear records are accurate.

4. Regarding blood transfusion, when the medical staff of the department go to the blood transfusion department to collect blood, they must check the "Clinical Blood Transfusion Application Form", cross-matching test report, blood bag label and blood appearance with the staff of the blood transfusion department. Only after both parties ensure accuracy and complete the signing procedures can blood be issued or collected. After the blood is sent to the department, two medical staff will check again whether the blood supply meets the requirements of the corresponding "Clinical Blood Transfusion Application Form" and confirm that all indicators meet the relevant requirements and are fully recorded. The nursing staff of the treatment class will go to the bedside of the recipient and verify the recipient's name, age, gender, disease diagnosis, blood type, department bed number, hospitalization number and other items again, and then use a standard transfusion device and follow strict aseptic techniques to execute the blood transfusion order. During the entire blood transfusion process, medical staff must also closely observe the recipient's reactions (including consciousness, body temperature, respiration, pulse, blood pressure, etc.) and changes in his or her condition. If the recipient has an abnormal reaction, the transfusion must be stopped immediately in serious cases, and the cause must be identified and dealt with as quickly as possible. At the same time, the remaining blood in the original bag must be properly preserved, any abnormal reactions must be recorded and reported to the blood transfusion department and the medical department.

5. After the blood transfusion, the nurse needs to carefully check the recipient's venous puncture site to ensure that there is no hematoma or bleeding, and take appropriate treatment measures. The nurse also needs to file the blood transfusion-related test results in the medical record. The attending physician needs to evaluate the efficacy of the blood transfusion and prevent the subsequent delayed hemolytic transfusion reaction.

Fund projects: 2023 Jing'an District Science Popularization Project (KP2023055); 2023 Jing'an District Health Science Popularization Leading Project; Shanghai Health Science Popularization Youth Talent Capacity Improvement Project (JKKPYC-2023-B14)

Author: Shanghai Jing'an District Central Hospital

Dr. Xia Lemin