Case A1: Unexpected Hemolysis in a Post-Partum Mother

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Last Updated: Oct. 10, 2016 [All links fixed]

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Contributed by: Pat Wrigley, ART Langley Memorial Hospital Blood Transfusion Service

History   Medications
 Mrs. JS is a 36-year-old expectant mother of 3 booked for Cesarian section (C/S) due to transverse position of baby.

  • Transfusions: 18 years ago

  • Pregnancies: Gravida 5; Para 3

     
  • Potassium chloride
  • Antacid
  • Ferious gluconate
  • Folic Acid
  • Lorazepa
  • Acetominophen
  • Clindamycin
  • Ipratrop
  • Dimenhydrinate
  • Erythromycin
  • Morphine
  • B12
  • Saline
  

HOSPITAL TRANSFUSION SERVICE TESTING

October 28, 1999

See initial compatibility test results

  • Normal test results

  • Blood not transfused

November 3, 1999

  • Patient returned to Operating Room for emergency hysterectomy due to uncontrolled bleeding

  • Transfused with 11 units crossmatch-compatible group O Rh positive RBCs and 8 FFP

November 11, 1999

  • Discharged with daughter

November 19, 1999

See these workups:

Summary of Initial Findings

  • DAT positive with anti-IgG

  • Antibody screen and all units positive at IAT

  • Suspect delayed hemolytic transfusion reaction

  • Color of plasma is a key indicator

Where to Start?

  • Eluate important to begin ASAP

  • Plasma panels but they are of little use in determining specificity

  • Finding pre-transfusion specimen is a gold mine to resolution of this case.

  • Consult RT.010 and TMP0021 (Transfusion reaction investigation)

CASE SUMMARY AND QUIZ

After reviewing the case summary, consider these questions:

  1. What are the common symptoms of delayed transfusion reaction?

    Answer

  2. Why was prewarm LISS used to crossmatch donor units with the post reaction specimen?

    Answer

  3. Why was phenotype matched blood crossmatched?

    Answer

FURTHER READING

British Columbia Provincial Blood Coordinating Office. Technical resource manual for hospital transfusion services. Vancouver: Provincial Blood Coordinating Office;2000. See RT.010 (Investigation of transfusion complications)

British Columbia Provincial Blood Coordinating Office. Technical operations manual. Vancouver: Provincial Blood Coordinating Office. See TMP0021 (Transfusion reaction investigation)

Schonewille, H., Haak, H.L., van Zijl, A.M. Alloimmunization after blood transfusion in patients with hematologic and oncologic diseases. Transfusion 1999 Jul;39(7):763-71.[ Medline ]

Schonewille H, Haak HL, van Zijl AM. RBC antibody persistence. Transfusion 2000 Sep;40(9):1127-31. [ Medline ]

Vamvakas EC, Pineda AA, Reisner R, Santrach PJ, Moore SB. The differentiation of delayed hemolytic and delayed serologic transfusion reactions: incidence and predictors of hemolysis. Transfusion 1995 Jan;35(1):26-32. [ Medline ]

Pineda AA, Vamvakas EC, Gorden LD, Winters JL, Moore SB. Trends in the incidence of delayed hemolytic and delayed serologic transfusion reactions. Transfusion 1999 Oct;39(10):1097-103. [ Medline ]