apple Posted December 4, 2009 Share Posted December 4, 2009 hello every body..few days a go we had this case and i would like to share it with all of you, we might find something to help this patient; We have 14 years old female patient with AML, she was receiving a lot of products lately , but 3 days ago once she relived the blood few minutes later she developed Transfusion reaction, we did all the work up nothing wrong except that we found her post and pre DAT positive and IgG and C3d negative, she developed fever, techacardia and hypotension.the next day she received FFP 2 units , and platelets no problemthe day after she received PRBC again the same symptoms..and they stooped the transfusion immediately. ( fever, hypotension and tachycardia...etc)We did all transfusion reaction work up this time..the same except that we have IgG and C3d positive, so we did Elution but its negative.The 3 screening cell is positive only the AC is negative.In immediate spin cross match nothing is compatible...so what do you think about that is TRALI, TACO or just febrile Reaction , and what is the way to solve it?Thanks and happy holiday… Link to comment Share on other sites More sharing options...
apple Posted December 4, 2009 Author Share Posted December 4, 2009 Correction:the 3 screening cell is negative only the AC is positive. Link to comment Share on other sites More sharing options...
RR1 Posted December 4, 2009 Share Posted December 4, 2009 What other results did you get: Pre and Post Hb, Pre and Post Bilirubin. Also what technique and method are you using for all the screening performed? Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 4, 2009 Share Posted December 4, 2009 It's not TRALI, as the symptoms don't fit, and it is unlikely to be TACO.It could be a febrile non-hemolytic transfusion reaction, even if the DAT is positive, as it was positive in the pre-transfusion sample. Look for HLA antibodies and consider leucodepletion.It worries me that you performing an immediate spin cross-match in such a case. Link to comment Share on other sites More sharing options...
apple Posted December 4, 2009 Author Share Posted December 4, 2009 Thanks guys for your fast replay…Malcolm..at the beginning we used to do IS crossmatch but after the last reaction we advice the technologist to proceed for AHG crossmatch and give washed PRBC. maybe that will help...what do you think? Link to comment Share on other sites More sharing options...
apple Posted December 4, 2009 Author Share Posted December 4, 2009 I forget to mention that all the products she received was Irradiated and leucoreduced. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 4, 2009 Share Posted December 4, 2009 I forget to mention that all the products she received was Irradiated and leucoreduced.In that case it could, just possibly, be a anti-IgA, although I would have expected that there would also have been quite a hefty reaction to the plasma and platelets.:confused: Link to comment Share on other sites More sharing options...
RR1 Posted December 4, 2009 Share Posted December 4, 2009 (edited) I would have also thought that if this was anti-IgA the reaction would have been more observable with the plasma and platelets, and fairly intense too. Do you have the Hb and Bilirubin results to see if any destruction could be occurring? Edited December 4, 2009 by RR1 Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 4, 2009 Share Posted December 4, 2009 Um, that's what I said Rashmi!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
JOANBALONE Posted December 4, 2009 Share Posted December 4, 2009 Just for fun, maybe do a complete panel even though the three cell screen is negative (as clarified earlier) and do AHG crossmatch on samples from the transfused units.JB Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 4, 2009 Share Posted December 4, 2009 Just for fun, maybe do a complete panel even though the three cell screen is negative (as clarified earlier) and do AHG crossmatch on samples from the transfused units.JBI totally agree with you Joan. Link to comment Share on other sites More sharing options...
jayinsat Posted December 4, 2009 Share Posted December 4, 2009 I would also run a panel of cells that include some of the low-frequency antigens like Cw, V, Diego etc. You might try giving washed units just in case the patient is reacting to some other plasma protein. Link to comment Share on other sites More sharing options...
apple Posted December 4, 2009 Author Share Posted December 4, 2009 Well , ya that what got me confused because whenever she took platelets or FFP she is ok, but she got this reaction only with PRBC, well I know her latest Hb is 7 thats all what I know for now...tomorrow I will get all the result. Link to comment Share on other sites More sharing options...
Fluffy agglutinates Posted December 8, 2009 Share Posted December 8, 2009 Just out of interest was the pre-transfusion sample a 'true' pre sample? - by that I mean you say the patient has received a lot of products lately, had they had red cells in the weeks leading up to the reaction?I personally would be screening this patient every 72hrs for developing antibodies. However, it is very unusual to have this sort of immediate reaction when dealing with red cell antibodies other than ABO (I presume that was definitely ruled out!). You could consider a Kidd antibody. Try an enzyme IAT panel & see if anything pops up. You could also put the eluate up by enzyme IAT too.It would be interesting to see what happens next - please keep us posted.p.s.I would expect that an autoantibody will be appearing in your screen soon... Link to comment Share on other sites More sharing options...
apple Posted December 12, 2009 Author Share Posted December 12, 2009 Hi fluffy, well that patient took blood so many times before transfusion reaction episode , I did every thing and its negative, what we did later just advice the dr. to premeditate before transfusion and we provide washed PRBC's …and guess what..its work. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 13, 2009 Share Posted December 13, 2009 Hi fluffy, well that patient took blood so many times before transfusion reaction episode , I did every thing and its negative, what we did later just advice the dr. to premeditate before transfusion and we provide washed PRBC's …and guess what..its work.This strengthens the possibility of an HLA antibody or still, just possibly, an antibody against IgA.:) Link to comment Share on other sites More sharing options...
Fluffy agglutinates Posted December 14, 2009 Share Posted December 14, 2009 Hi fluffy, well that patient took blood so many times before transfusion reaction episode , I did every thing and its negative, what we did later just advice the dr. to premeditate before transfusion and we provide washed PRBC's …and guess what..its work.It's a very interesting case! Seems very unusual to only react in that way to red cells. May be you should get this written up? Thanks for sharing it. Link to comment Share on other sites More sharing options...
Yanxia Posted December 15, 2009 Share Posted December 15, 2009 Maybe she react with red cells preservation fluid. Link to comment Share on other sites More sharing options...
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