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Case Study A1 - Case Summary
 

TraQ Program of the BC PBCO

Thursday, 23 November 2017

Case Study A1 - Case Summary

1999

History

Mrs. JS is a 36-year-old expectant mother of 3 booked for Caesarian section (C/S) due to transverse position of baby.

October 28

  • Group O Rh positive,
  • Antibody screen negative by PEG-IAT
  • Hemoglobin 129 g/dL

November 2

  • C/S uneventful, healthy female baby born
  • Request for STAT 4 unit crossmatch for possible post-partum hemorrhage

November 3

  • Patient returned to Operating Room for emergency hysterectomy due to uncontrolled bleeding
  • Transfused with 11 units RBCs and 8 FFP

November 11

  • Discharged with daughter.
  • Maternal hemoglobin 92 g/dL and creatinine 117 umol/L

November 19

Patient returned to family physician with abdominal pain and jaundice. Family physician examined patient and sent her to the hospital emergency department. Emergency physician orders hemoglobin and a 3 unit crossmatch.

Results: Initial Investigation

  • Hemoglobin result reported as 59 g/dL with report of brown plasma
  • Creatinine 117 umol/L
  • Hematopathologist alerted along with attending physician
  • DAT positive, antibody screen positive
  • All panel cells positive
  • Proceeded to eluate

Results: Follow-up Investigation

  • Consulted with referral hospital
  • Reviewed transfusion history and medications
  • Eluate does not show specificity
  • Retrieved pre-transfusion specimen from October 28. Centrifuged and found very limited volume of plasma left.
  • Full antigen phenotype done on October 28 (pre-transfusion) specimen
  • CBS contacted to provide 4 "phenomatched" RBC units
  • Advised evening Lab and ER staff that units should be crossmatched if a request for transfusion was received.

Outcome

Mrs J.S. was transfused with one unit of O Rh Negative Jk(b-), S-, K-, Fy(a-) RBC on November 20. She was discharged on November 24 with a hemoglobin of 78 g/dL.

2000

January

CBS reports results of antibody investigation:

  • anti-E
  • anti-Fya
  • probable anti-K and an HTLA antibody
Last modified on Monday, 04 July 2011 14:06