BLOOD BANK CASE STUDY

By: Melissa Harding

BACKGROUND

A 60-year-old male was admitted to the hospital for surgery.

Diagnosis-prostate cancer.

The patient was taken to the operating room and the surgery was started.

No pre-surgical type and screen work-up had been performed. A stat blood sample was sent to the lab with a request for type and crossmatch of 2 units of packed red blood cells.

TRANSFUSION HISTORY

No history of transfusion. No prior blood bank history.

LAB RESULTS

Blood type: A+ Antibody Screen: Negative

2 units of A+ packed RBCs, crossmatch compatible were issued to the OR for this patient.

TRANSFUSION OF THE RBCS

After transfusion of approximately 100mL of the first unit, in the OR, oozing was seen from the surgical and intravenous sites. The patients blood pressure fell to 75/35 mmHg (pre-transfusion value 110/65 mmHg). The transfusion was stopped and investigation of a transfusion reaction was initiated. Additional 2 units of RBCs were requested.

What samples and materials must be sent to the lab as part of the initial work up?

Blood sample for repeat type and screen Remainder of the implicated unit together with the intravenous tubing. The untransfused unit. First voided urine.

RESULTS OF REPEATED ABO & RH TYPING

Sample Patient Post-tx Patient Pre-tx Transfused Unit 2nd Unit AntiA AntiB Anti-D Rh Control 1+ mf 0 0 0 A1 Cells 2+ 0 0 0 B Cells 3+ 3+ 2+ 2+

1+ mf 1+ mf 3+ 4+ 4+ 4+ 0 0 0 3+ 4+ 4+

What is the significance of the mixed field reactions?

Mixed field reaction denotes that more than one population of cells is present.

RESULTS OF THE DAT

Samples

Polyspecific AHG 2+ mf

Anti-IgG

Anti-C3d

Post-tx

2+ mf

2+ mf

Pre-tx

ANTIBODY SCREEN ON THE POSTTRANSFUSION SAMPLE

Screening Cells I IS IAT CC

2+

II

2+

III

2+

Based on the investigation what is the most likely cause of the hemolytic transfusion reaction?

The transfusion of ABO incompatible blood. The reverse type showed the presence of both anti-A and anti-B, suggesting that the patients correct blood type is most likely group O positive.

CONCLUSION

It is discovered that the initial pre-transfusion sample received in the blood bank was drawn from a different patient and labeled incorrectly which resulted in the ABO incompatible transfusion.

What should be done next once this is discovered?

Inform the physician right away what happened. Check with the other patient to make sure that they have not received any transfusions.