Question

Chapter 17( Immunohematology and Transfusion Medicine)

A 17-year-old man is admitted with multiple injuries after his motorcycle crashes. The emergency department physician draws a blood sample for a STAT type and crossmatch. The motorcyclist's passenger also has blood drawn for a STAT type and screen. An immediate-spin crossmatch is compatible between the group A patient and group A donor. The unit of blood is issued from the blood bank as an emergency release. After receiving 50 mL of the first unit of RBCs, the man develops shaking chills and becomes hypotensive with a falling blood pressure. The unit of cells is immediately discontinued, and the transfusion service is notified of the situation. A recheck of testing is requested immediately.

Laboratory Testing Clerical check:

No evidence of clerical errors

Hemoglobinemia: Slight hemolysis observed

Direct antiglobulin test

Patient pretransfusion: Negative

Patient posttransfusion: Weakly positive

Recheck of blood grouping

pretransfusion: A positive Patient

posttransfusion: O positive

Donor: A positive

Repeat crossmatches

Patient pretransfusion + Donor red blood cells = Compatible

posttransfusion + Donor red blood cells = Incompatible

Critical Thinking Group Discussion

1. Why did this patient experience shaking chills and other adverse effects after receiving only 50 mL of red blood cells?

2. If the patient's adverse reaction to the blood transfusion had not been noted soon after the beginning of the transfusion, what physiologic changes would have occurred to the patient?

Answer 1

1. The patient experienced adverse effects and shaking chills. This occurred due to the pathological processs of systemic agglutination. This occurred due to mismatch of blood and receiving blood from incorrect donor. This might have occurred due to false deviation of crosss matching result leading to the error. The agglutination reaction lead to hemolysis, which led to development of the symptoms.
2. If the transfusion was not stopped earlier and was allowed to continue, the agglutination reaction would have become fatal. There would have occurred intravascular coagulation of blood with activation of all immune responses. A loss in blood contents, could lead to decrease in oxygen transport leading to respiratory distress. As the agglutination reaction proceeds, the afterload and preload on the heart increases leading to the heart failure. There could have occurred multi-systemic failure as a response to inflammation and hypersensitivity reactions leading to state of shock and death.