Posted November 7, 2024Nov 7 comment_91192 Hi We Received URGENT request for 1 unit of blood transfusion for 1 year old child who had previous transfusion at abroad due Thalassemia Major. This was patient 1st visit in the UK therefore Rh and K phenotype was not known . As per guidelines Rh and K phenotype performed. Rh phenotype results obtained as below C mf E 4+ c+4 e4+ K mf. (Probably R2r) Because patients was previously transfused at other country sample was sent for genotype which will take 2 weeks to get results back. Due to clinical condition, patient, required urgent transfusion therfore with Haematology consultation 1 unit of blood C-K- blood issued by IAT xmatch. Meanwhile sample was sent for Rh genotype and results received as C+E-c-e+ (R1R1). Totally different phenotype result Why? I know patient had multiple transfusion at abroad. But never seen. Thankfully we had consultant approval to issue C-K- blood. Lesson learned always involve clinical team to decide. Any further comments Edited November 7, 2024Nov 7 by gagpinks
November 14, 2024Nov 14 comment_91275 On 11/7/2024 at 2:01 PM, gagpinks said: Hi We Received URGENT request for 1 unit of blood transfusion for 1 year old child who had previous transfusion at abroad due Thalassemia Major. This was patient 1st visit in the UK therefore Rh and K phenotype was not known . As per guidelines Rh and K phenotype performed. Rh phenotype results obtained as below C mf E 4+ c+4 e4+ K mf. (Probably R2r) Because patients was previously transfused at other country sample was sent for genotype which will take 2 weeks to get results back. Due to clinical condition, patient, required urgent transfusion therfore with Haematology consultation 1 unit of blood C-K- blood issued by IAT xmatch. Meanwhile sample was sent for Rh genotype and results received as C+E-c-e+ (R1R1). Totally different phenotype result Why? I know patient had multiple transfusion at abroad. But never seen. Thankfully we had consultant approval to issue C-K- blood. Lesson learned always involve clinical team to decide. Any further comments May I ask what was the patient's type and screen result prior to any transfusion?
November 15, 2024Nov 15 comment_91305 We would honor the molecular typing and provide E-, c-, and K- red cells for this patient moving forward. Your serologic typing results are not valid due to recent transfusion, and this isn't an uncommon genotype for a thalassemia patient. Unfortunately this means that the patient received c pos units (when you gave C-, K- red cells), but that was the best you could do without knowing that information before the first transfusion was ordered at your facility. We come across this frequently with new/relocated sickle and thalassemia patients.
November 16, 2024Nov 16 comment_91319 I just can't understand why the phenotype gives 4+ of c antigen when the genotype is c neg.
November 21, 2024Nov 21 Author comment_91397 On 11/14/2024 at 7:13 AM, SbbPerson said: May I ask what was the patient's type and screen result prior to any transfusion? Patient blood group is A Rh D positive and antibody screen negative
November 21, 2024Nov 21 Author comment_91398 On 11/15/2024 at 2:26 PM, Townsend said: We would honor the molecular typing and provide E-, c-, and K- red cells for this patient moving forward. Your serologic typing results are not valid due to recent transfusion, and this isn't an uncommon genotype for a thalassemia patient. Unfortunately this means that the patient received c pos units (when you gave C-, K- red cells), but that was the best you could do without knowing that information before the first transfusion was ordered at your facility. We come across this frequently with new/relocated sickle and thalassemia patients. How do you deal with this situation at your end?
November 21, 2024Nov 21 Author comment_91399 On 11/16/2024 at 6:43 AM, Yanxia said: I just can't understand why the phenotype gives 4+ of c antigen when the genotype is c neg. I guess patient might have multiple transfusion c+ in home country where they don't perform Rh phenotype.
November 21, 2024Nov 21 comment_91400 1 hour ago, gagpinks said: Patient blood group is A Rh D positive and antibody screen negative 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). Edited November 21, 2024Nov 21 by SbbPerson
Create an account or sign in to comment