Mrs. JS is a 36-year-old expectant mother of 3 booked for Caesarian section (C/S) due to transverse position of baby.
- Group O Rh positive,
- Antibody screen negative by PEG-IAT
- Hemoglobin 129 g/dL
- C/S uneventful, healthy female baby born
- Request for STAT 4 unit crossmatch for possible post-partum hemorrhage
- Patient returned to Operating Room for emergency hysterectomy due to uncontrolled bleeding
- Transfused with 11 units RBCs and 8 FFP
- Discharged with daughter.
- Maternal hemoglobin 92 g/dL and creatinine 117 umol/L
Patient returned to family physician with abdominal pain and jaundice. Family physician examined patient and sent her to the hospital emergency department. Emergency physician orders hemoglobin and a 3 unit crossmatch.
Results: Initial Investigation
- Hemoglobin result reported as 59 g/dL with report of brown plasma
- Creatinine 117 umol/L
- Hematopathologist alerted along with attending physician
- DAT positive, antibody screen positive
- All panel cells positive
- Proceeded to eluate
Results: Follow-up Investigation
- Consulted with referral hospital
- Reviewed transfusion history and medications
- Eluate does not show specificity
- Retrieved pre-transfusion specimen from October 28. Centrifuged and found very limited volume of plasma left.
- Full antigen phenotype done on October 28 (pre-transfusion) specimen
- CBS contacted to provide 4 "phenomatched" RBC units
- Advised evening Lab and ER staff that units should be crossmatched if a request for transfusion was received.
Mrs J.S. was transfused with one unit of O Rh Negative Jk(b-), S-, K-, Fy(a-) RBC on November 20. She was discharged on November 24 with a hemoglobin of 78 g/dL.
CBS reports results of antibody investigation:
- probable anti-K and an HTLA antibody