c



c 

a

 
 

   

Objectives

1.| Identify the cause of hemolytic transfusion reaction in the case presented.
2.| Give possible solution that could reduce the incidence of platelet transfusion incompatibility.

Clinical Description

-| Immune-mediated transfusion reaction

-| Rapid destruction of red cells immediately or within 24 hours of transfusion
-| Incompatible blood administration
-| Recipient antibodies directed against donor red cell antigens
-| Typically occurs with patients receiving type O blood who are not type O
-| Most common cause is




-| On occasion may be due to transfused ABO antibodies (platelet transfusions)

Pathophysiology

-| Antibodies to A and B antigens are usually most severe (intravascular hemolysis)

-| Antibodies inactivate antigens by complement fixation
-| Proteins attach to antigen surface and cause holes
-| Free hemoglobin is released to plasma

Conditions that Destroy Recipient RBCs

-| ABO incompatible plasma, cryoprecipitate, or plasma-derived products

-| Infusion of large amounts of hypotonic solutions
-| Mechanical trauma (mechanical heart valves, microangiopathic syndromes)

Clinical Manifestations

-| Fever
-| Rigors (Chills)
-| Nausea
-| Anxiety
-| Chest pain or tightness
-| Lower back and flank pain
-| Pain in transfusion site or along infusion vein
-| Icterus (Jaundice)
-| Hypotension
-| Dyspnea
-| Hemoglobinuria
-| Hemoglobinemia
-| Diffuse bleeding from mucous membranes

Factors Affecting Clinical Manifestations

-| antigen involved
-| quantity of RBC infused
-| titer of antibody
-| thermal range of antibody activity
Diagnostic Approach

| tandard Investigation
u| Clerical check
[| Labeling errors
[| Patient identification errors

u| risual check
[| Observe for hemolysis
u| Post ABO
[| Compare to pre-transfusion ABO
u| Post DAT
[| Detect incompatibility
| Laboratory Investigation
u| Blood Bank
[| DAT
[| Antibody screening PRE and POT
[| AHG cross-matching PRE and POT
[| Antibody studies
[| Antibody enhancement studies
u| Hematology
[| CBC
[| Platelet count
[| Haptoglobin
[| Coagulation studies
u| Clinical Microscopy
[| rinalysis
u| Clinical Chemistry
[| LDH
[| Bilirubin
[| BN
[| Creatinine

Characteristic Laboratory Findings

-| Decreased hemoglobin
-| Decreased hematocrit
-| Decreased serum haptoglobin
-| Increased bilirubin

Transfusion Work-p

!

  The patient was a 79 year old male diagnosed with myelodysplastic syndrome with weekly platelet and
red cell transfusions since diagnosed

 
  Blood type A, Rh negative.

c
  No antibodies detected.

    Patient was transfused with one unit of Group O, Rh positive buffy coat pooled platelets at 14  1. At 15 20,
the patient showed signs of distress and the following symptoms were noted;

-| itting forward with sever back pain

-| Oxygen saturation at 69%
-| Dyspnea
-| Chest pain
-| light rise of temperature from 6.0 °C pre-transfusion to 6. °C at time of reaction


    !    !
     

 

 
 

 No icteris No icteris No icteris No icteris
No hemolysis No hemolysis Gross hemolysis No hemolysis @ 07 20
c Anti-IgG weak
Anti-C D


  ʹ 22 umol/L 20 umol/L 74 umol/L
 1 ʹ 618 /L 1 022 /L 1 996 /L
 1 5 ʹ 180 g/L 99 g/L 81 g/L
  pherocytes
chistocytes


 0. ʹ 1.7 g/L Less than 0.12

    Gross hemolysis Clear urine @ 01 05

 < 0.0 4 ng/mL 0.09 ng/mL 0.267 ng/mL @ 21 09
0.97 ng/mL @ 01 05


 Anti-A titer

!
 60 mins @ Room Temperature AHG

 1 64 1 1024