Case A1: Unexpected Hemolysis in a Post-Partum Mother
Last Updated: Sept. 19, 2019 [Fixed link to TMP0021]
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Contributed by: Pat Wrigley, ART Langley Memorial Hospital Blood Transfusion Service
|Mrs. JS is a 36-year-old expectant mother of 3 booked for Cesarian section (C/S) due to transverse position of baby.
HOSPITAL TRANSFUSION SERVICE TESTING
October 28, 1999
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.
CASE SUMMARY AND QUIZ
After reviewing the case summary, consider these questions:
What are the common symptoms of delayed transfusion reaction?
Why was prewarm LISS used to crossmatch donor units with the post reaction specimen?
Why was phenotype matched blood crossmatched?
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)
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 ]