Case A4: Positive DAT in a Recently Transfused Nonagenarian
Last Updated: Oct. 12, 2016 [All links updated]
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Contributed by: Darlene Mueller, ART, Matsqui - Abbotsford - Sumas (MSA) General Hospital
Mrs. A.L., a 91-year-old female, was admitted for left hip surgery on April 2. Her hemoglobin was 92g/L and two units of RBC were ordered for her surgery
- Pregnancies: 3 prior pregnancies
- Transfusion: 2 units of RBC 9 years ago with no adverse reactions
- Initial crossmatch results (need new link)
Based on these results, Mrs. AL was transfused with two units of RBC on April 2. No adverse reaction was reported.
Twelve weeks later, Mrs. AL was admitted to hospital for complication of the left hip. Two units of RBC were ordered for her surgery.
The transfusion service technologist notified the attending physician and surgeon that the patient?s antibody screen was positive and compatible blood would be delayed. The post-transfusion specimen showed no visible hemolysis or icterus.
- Antibody identification (post-transfusion plasma)
- Direct antiglobulin test
- Patient's phenotyping
- Antibody identification (eluate)
- Summary of panels, phenotyping, and exclusion cells
- Post-investigation crossmatch results
CASE SUMMARY AND QUIZ
After reviewing the case summary, consider these questions.
With regard to delayed hemolytic transfusion reactions (DHTR):
- Which antibodies are commonly involved?
- How long following transfusion do they usually occur?
- What are the main symptoms?
- What is the prognosis and treatment?
- Which non-serological laboratory test results may be helpful when investigating DHTR?
- How are such reactions usually discovered and how do they present in the transfusion service?
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 ]
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 ]