delayed hemolytic transfusion reactions...case study 1 (cont.) •delayed transfusion reaction...
TRANSCRIPT
Delayed Hemolytic Transfusion Reactions
Jennifer Jenkins MPH, MLS
UK Good Samaritan Hospital
Objectives
• Compare and contrast acute versus delayed transfusion reactions
• Look at the lab values associated with delayed transfusion reactions
• Discuss mixed-field reactions associated with delayed transfusion reactions
Signs/Symptoms
Acute Hemolytic Transfusion Reaction (<24 hrs post transfusion)
Delayed Hemolytic Transfusion Reaction (Usually within 3-21 days)
Fever (≥1°C or 2°F) Fever
Chills Unexplained fall in Hemoglobin
Renal Failure Renal Failure (rare)
Hemoglobinuria Hemoglobinuria
Hypotension
DIC (Disseminated Intervascular Coagulation)
Back Pain
Pain along infusion vein
Oliguria
Oozing from I.V. site/surgical incision
Laboratory tests to consider
• Direct Antiglobulin Test (DAT)
– IgG
– Complement
– Medications
• New Antibody Identified
– Eluate
– Kidd system
• Titers fall quickly
Laboratory tests to consider (cont.)
• Bilirubin – Increased due to RBC destruction
• liver disease, such as hepatitis
• hemolytic anemia
• cirrhosis, scarring of the liver
• biliary stricture, where part of the bile duct is too narrow to allow fluid to pass
• cancer of the gallbladder or pancreas
• gallstones
• drug toxicity
Laboratory tests to consider (cont.)
• LDH – Increased due to RBC destruction
• blood flow deficiency • cerebrovascular accident • certain cancers • heart attack • hemolytic anemia • infectious mononucleosis • liver disease • muscle injury • muscular dystrophy • pancreatitis • tissue death • use of alcohol or certain drugs • sepsis and septic shock
Case Study 1
• 38 year old female
• O Positive
– Received 2 units O Pos on 4/29
• New Specimen Drawn 5/11 showed Anti-Jka
– 1 Jka negative unit was given
Antibody Screen
Panel A
Panel B
Case Study 1 (cont.)
• Delayed transfusion reaction workup showed
– negative DAT
– no visible hemolysis
– one of the units the patient had received on 4/29 was Jka positive
– Reticulocyte harvest showed negative for the Jka antigen
Case Study 2
• 67 year old female
• A Neg
– Switched to Rh Positive units per pathology
• Decreasing RBCs post surgery
• Emergency uncrossmatched units ordered just after specimen expired at midnight for code
• 4 uncrossmatched units O Pos issued
Antibody Screen
Panel A
Case Study 2 (cont.)
• Antibody Screen positive
• Called to switch to O neg
– Took 12 O neg units total
• Negative DAT
• Mixed Field with D Typing
Questions?
Sources
• Fung, Mark K., Brenda J. Grossman, Christopher D. Hillyer, and Connie M. Westhoff.Technical Manual. Bethesda, MD: American Association of Blood Banks, 2014. Print.
• "Blood Bank Guy Home Page - Joe Chaffin, MD." Blood Bank Guy. N.p., n.d. Web. 17 Aug. 2017.
• Reid, M. E., Lomas-Francis, C., & Olsson, M. L. (2012). The blood group antigen. Amsterdam: Elsevier/Academic Press.