Case A1: Unexpected Hemolysis in a Post-Partum Mother
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Last Updated: Sept. 19, 2019 [Fixed link to TMP0021]
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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.
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HOSPITAL TRANSFUSION SERVICE TESTING
October 28, 1999
See initial compatibility test results
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Normal test results
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Blood not transfused
November 3, 1999
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Patient returned to Operating Room for emergency hysterectomy due to uncontrolled bleeding
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Transfused with 11 units crossmatch-compatible group O Rh positive RBCs and 8 FFP
November 11, 1999
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Discharged with daughter
November 19, 1999
See these workups:
Summary of Initial Findings
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DAT positive with anti-IgG
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Antibody screen and all units positive at IAT
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Suspect delayed hemolytic transfusion reaction
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Color of plasma is a key indicator
Where to Start?
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Eluate important to begin ASAP
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Plasma panels but they are of little use in determining specificity
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Finding pre-transfusion specimen is a gold mine to resolution of this case.
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Consult RT.010 and TMP0021 (Transfusion reaction investigation)
CASE SUMMARY AND QUIZ
After reviewing the case summary, consider these questions:
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What are the common symptoms of delayed transfusion reaction?
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Why was prewarm LISS used to crossmatch donor units with the post reaction specimen?
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Why was phenotype matched blood crossmatched?
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 ]