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Case A1: Unexpected Hemolysis in a Post-Partum Mother (JS)

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 Caesarian 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

Case Summary and Quiz

After reviewing the case summary, consider these questions:

  1. What are the common symptoms of delayed transfusion reaction? [View Answer]

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

  3. Why was phenotype matched blood crossmatched? [View 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.

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 ]

 
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