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Aah okay, I guess you answered your own question. The mixed field C result is perhaps due to the dual population of blood transfused. Some may have been C+ and some C-. c+ is a common antigen, almost 80% of Caucasians have it. That could explain the strong c 4+. Most place don't do phenotyping after multiple transfusions because of possible dual rbc population , so yes, Townsend is right, "honor the genotyping and provide E-, c-, and K- red cells for this patient moving forward"(Townsend).

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May I ask what was the patient's type and screen result prior to any transfusion?

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