Last Updated July 11, 2011
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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
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.
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.
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.
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:
After reviewing the case summary, consider these questions:
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 ]