Case A2: Falling Hemoglobin in a Recently Transfused Patient
Last Updated: Oct. 10, 2016 [All links fixed]
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Contributed by Daryl Gouthro, RT St Paul's Hospital Transfusion Service, and Sylvia Luther, RT Matsqui - Abbotsford - Sumas (MSA) General Hospital Transfusion Service
ST. PAUL'S HOSPITAL
Mr. F.S. is a 51 year old male diagnosed with recurrent carcinoma of the rectum that is invading the bladder. He was previously diagnosed in 1997 when he underwent a colostomy and post-op radiation.
Hospital Transfusion Service Testing
October 19, 2000
Mr F.S. attended the pre-assessment clinic at St. Paul's Hospital. His preoperative hemoglobin was 140 g/L. Laboratory SOP states that type and screen samples are held for one month if there is no history of transfusion in the prior three months.
October 24, 2000
Four units of red blood cells (RBC) were requested and, after an electronic crossmatch, all four RBC units were transfused in the Operating Room.
Post-operatively Mr. F.S.'s hemoglobin was 106 g/L and slowly dropped to 88 g/L on the 7th day post op. No additional type and screen requests were received.
Mr. F.S. was discharged from St. Paul's Hospital on 31 October, 2000.
MSA GENERAL HOSPITAL
November 4, 2000
Mr. F.S. was sent to the MSA hospital laboratory for blood work. His hemoglobin was 78 g/L and an increased WBC and platelet counts. Plasma urea and creatinine results were normal. History check revealed previous transfusion at MSA Hospital on October 16, 1997.
Subsequently, a 4-unit crossmatch was ordered. See these workups:
- Type and Screen and DAT
- Antibody Identification (Panel 1)
- Antibody Identification (Panel 2)
- Summary of Panels, Selected Cells and Self Test
- Patient Phenotyping (Pretransfusion Specimen)
CASE SUMMARY AND QUIZ
After reviewing the case summary, consider these questions:
- What could account for the DAT being negative when Mr. F.S. appears to be experiencing a delayed hemolytic transfusion reaction?
- Describe the course of alloimmunization to red cell antigens.
- When multiple antibodies are present, which antigen should be typed for first? Besides typing with commercial antisera, are there other ways to screen donors?
- How common is it for patients with serologic evidence of delayed hemolytic transfusion reactions to experience clinical symptoms?
British Columbia Provincial Blood Coordinating Office. Technical resource manual for hospital transfusion services. Vancouver: Provincial Blood Coordinating Office;2000.
Heddle NM, Soutar RL, O'Hoski PL, Singer J, McBride JA, Ali MA, Kelton JG. A prospective study to determine the frequency and clinical significance of alloimmunization post-transfusion. Br J Haematol 1995 Dec;91(4):1000-5. [ Medline ]