Amemia secondary to MDS

[WCHBB]

Thanks, you all have been of great help and support to me. Cyndie

[galvania]

Could it be that something in the first and/or second unit reacted against something in the third? You could try doing a cross match amongst the units of blood.

Also, were the post transfusion samples that were haemolysed drawn from the vein directly or from the port. If it's the port, could something in the port be causing the haemolysis.

I presume you have done the necessary bacteriological checks, and other checks for causes of non-immune haemolysis.

A note about IgA. Some polyspecific Coombs reagents will (deliberately) cross-react with IgA, so they would pick up at least the stronger ones - but like Malcolm says, it is unlikely to cause haemolysis.

[Malcolm Needs ☆]

Could it be that something in the first and/or second unit reacted against something in the third? You could try doing a cross match amongst the units of blood.

Also, were the post transfusion samples that were haemolysed drawn from the vein directly or from the port. If it's the port, could something in the port be causing the haemolysis.

I presume you have done the necessary bacteriological checks, and other checks for causes of non-immune haemolysis.

A note about IgA. Some polyspecific Coombs reagents will (deliberately) cross-react with IgA, so they would pick up at least the stronger ones - but like Malcolm says, it is unlikely to cause haemolysis.

Hi Anna,

I'm sorry to be a bit of an old curmudgeon, but is it really likely to be something in the first and/or second unit reacting against something in the third? If it were so, the antigen would have to be on the red cells of the first and/or second unit, and the antibody in the plasma of the third (otherwise the antibody in the plasma of the first or second unit would be too dilute to cause much more than a delayed haemolytic transfusion reaction due to red cell sensitization and then removal by the reticuloendothelial system, rather than almost immediate haematuria), and even then, the titre of the antibody in the third unit would have to be pretty high.

I'm NOT for one minute saying that this cannot happen (we all know of the case in the literature of the anti-K in one unit reacting with another unit that was K+); all I'm saying is that, in this day and age of quality coming out of our ears, I just think it is unlikely.

PLEASE DON'T THINK I AM INSULTING EITHER YOU OR YOUR SUGGESTION. IF IT READS LIKE THAT, IT WAS NOT MEANT IN THAT VEIN AND PLEASE FORGIVE ME.

[BSIPHERD]

You said this had happened once in the past, before it happened at your location. It may be worth while to type out the donor. If it happens again, you could type out that donor and see if there is anything in common (i.e. both units K+ or both units ccDEE or both units Kp(a+). I think it would be worth while to also do AHG crossmatching for this patient in the future.

Interesting patient, keep us updated if any further developments! Thanks.

[galvania]

:)Dear Malcolm

Of course I don't think that. That's what's so great about this forum. We can all throw ideas into the melting pot and then everyone else can bring their collective experiences to bear on the subject and we can all learn from everybody else.

So sleep easy and have a nice day....

Anna:)

[RR1]

Hi everyone,

Just to show my ignorance, in the UK most of our blood components are packed red cells- is this the case in the U.S or are you stocking mainly whole blood in the hospital labs and packing down on site when required?

Also, is there a central 'body' that collects and tests donor units before transferring to the labs for patient testing....or lots of smaller organisations linked to the hospital blood banks?

In the UK the central NHSBT does all the donor collection / processing before transferring to hospital labs.

Many thanks.

[rescyth]

Ineffective hematopoiesis is sometimes misdiagnosed as hemolysis which is the case of MDS. Due to abnormal production, RBC breakdown occurs intravascularly which in turn...walahhh...urine in blood. or my other theory is PNH which is very common in people with bone marrow disorders.

i blame the disease for this one

for the reference...i think that was on HENRY or an article that i just happen to mistook for a PORN magz then got hook up reading it anyways !...

just my 2 cents