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comment_80882

Hello, I need help to understand this Acute Transfusional Hemolytic Reaction.

A patient under investigation for acute promyelocytic leukemia, after transfusion of red blood cells in group O, presented fever (38.6 ° C).

Immunohematological results of the patient:
- pre-transfusion: B negative, negative irregular antibody test, negative DAT, negative compatibility test

- post-transfusion: negative B, negative IAT, positive DAT 2+ (C3d only), negative compatibility test, negative eluate, negative anti-B test with eluate serum

Laboratory results:
- evidence of hemolysis: DAT + in the post-transfusion sample, hemoglobinuria, drop in Hb / Ht,
Elevation of lactic dehydrogenase.

Components installed on the right patient: YES

Transfusion within institutional protocols: YES

Questions?
What triggered this acute hemolytic reaction?
Which test to do now?

Edited by mpmiola

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  • We understand what happened. We received the patient 12 hours before this transfusion. Despite having denied previous transfusions, we contacted the health service of origin who informed us that he ha

  • Malcolm Needs
    Malcolm Needs

    Just as a matter of interest, were the samples tested by the Blood Bank for compatibility EDTA samples?  If so, it might be worthwhile testing a clotted sample (i.e., using serum in the tests, rather

  • Especially if the beast in question is largely IgM.

comment_80884

Just as a matter of interest, were the samples tested by the Blood Bank for compatibility EDTA samples?  If so, it might be worthwhile testing a clotted sample (i.e., using serum in the tests, rather than plasma) and using broad spectrum AHG.

It would be highly unusual, but it could be an antibody specificity (such as an anti-Vel) that requires active complement to be detected.

comment_80887
1 hour ago, Malcolm Needs said:

It would be highly unusual, but it could be an antibody specificity (such as an anti-Vel) that requires active complement to be detected.

Especially if the beast in question is largely IgM.

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comment_80888
2 hours ago, Malcolm Needs said:

Só por questão de interesse, as amostras foram testadas pelo Banco de Sangue para compatibilidade de amostras de EDTA? Nesse caso, pode valer a pena testar uma amostra coagulada ( ou seja , usando soro nos testes, em vez de plasma) e usar AHG de amplo espectro.

Seria altamente incomum, mas poderia ser uma especificidade de anticorpo (como um anti-Vel) que requer complemento ativo para ser detectado.

Thank you Malcolm, we do not test with serum, I will do the tests now

comment_80889
15 minutes ago, mpmiola said:

Thank you Malcolm, we do not test with serum, I will do the tests now

I hope I am not leading you down a blind alley!

comment_80898

Is there any chance of the anti-B in the donor packed cells caused the heamolysis?

Because the free antibodies attached to the patient's cells, complements actived and cells hemolysis, so there is no free anti-B detected after transfusion. 

Edited by yan xia
typo

  • Author
comment_80899
19 hours ago, mpmiola said:

Obrigado Malcolm, nós não testamos com soro, vou fazer os testes agora

We performed the tests with serum, everything negative.
The most likely suspicion is passive anti-B

comment_80901

Just curious but does your facility not stock a supply of group B blood?  I'm only wondering why group O was used for the transfusion.  Only idle curiosity.  

:coffeecup:

  • Author
comment_80913
On 26/08/2020 at 13:02, John C. Staley said:

Só por curiosidade, mas suas instalações não estocam sangue do grupo B? Só estou me perguntando por que o grupo O foi usado para a transfusão. Apenas curiosidade ociosa.  

:xícara de café:

We didn't have B- in stock

Edited by mpmiola
B-

  • Author
comment_80914

We understand what happened. We received the patient 12 hours before this transfusion. Despite having denied previous transfusions, we contacted the health service of origin who informed us that he had transfused platelets in pool (600 ML) the group O. Therefore, we believe that the reaction after red blood cell transfusion was a coincidence, and the anti-B of the transfused platelets must be the cause of hemolysis.

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