delay transfusion reaction

[newBB]

how do we know for sure when Hgb of patient is droped after transfused 3 untis a week ago . the patient has multiple antibodies transfused regularly . Hgb droped from 10 to 5 !! DAT is not always positive.

i like to know which biochemistry test tell me there is hemolysis . but how can we rule out other bleeding due to other illness ? confused

[Malcolm Needs ☆]

Excellent question newBB!

Could you let us know, by any chance, what is the underlying pathology that requires your patient to have these frequent transfusions, and whether this latest rapid drop in Hb post-transfusion is normal for him/her, or whether it is even more dramatic than normal?

This may help people decide which tests are pertinent, and which may be a complete and utter waste of time.

[tbostock]

Some tests that can show evidence of hemolysis in the patient:

Total bilirubin (increased)

LDH (increased)

Haptoglobin (decreased)

[Malcolm Needs ☆]

Some tests that can show evidence of hemolysis in the patient:

Total bilirubin (increased)

LDH (increased)

Haptoglobin (decreased)

True; I wouldn't argue with what you are saying at all, but if the underlying pathology involves red cell haemolysis (such as a warm, cold or mixed haemolytic anaemia, sickle cell anaemia, mechanical anaemic due to a heart valve replacement, etc, etc) these parameters may distort the results, giving a false indication of a true immune haemolytic transfusion reaction. This is why I was asking about the underlying pathological condition, and whether the drop in haemoglobin post-transfusion was unusually swift.

Without this information, I don't think that we can give a pertinent answer to the question posed. I got my self stung by making assumptions in another thread about antibodies with a positive auto and a positive DAT, but no free antibody identified in the antibody panel.

:surrender:surrender:surrender:surrender:surrender

[newBB]

Excellent question newBB!

Could you let us know, by any chance, what is the underlying pathology that requires your patient to have these frequent transfusions, and whether this latest rapid drop in Hb post-transfusion is normal for him/her, or whether it is even more dramatic than normal?

This may help people decide which tests are pertinent, and which may be a complete and utter waste of time.

the problem in blood bank we dont get the complete picture . they will fill in the request anemia only if sickle or thalassema will mention but if someone with many other illness wont be mentioned . so is there a test can tell me for sure that Hgb drop really realted to transfusion reaction ?due to what we issue to them ? i heard once the doctor said because we are giving them old blood so the hgb is dropping with his patient ! for me i just wnat to know that we didnot cuase any delay transfusion reaction

[Eagle Eye]

Can you contact physician and get more history?

Check urinalysis result..

Are you transfusing crossmatch compatible or best compatible units?

Are you giving phenotypically matched units?

[newBB]

Can you contact physician and get more history?

Check urinalysis result..

Are you transfusing crossmatch compatible or best compatible units?

Are you giving phenotypically matched units?

our policy we check the unrin color . our issue complete crossmatch with gellcard after panel we phenotype the units for the antidbodiy identified. but i do worry if there is any new antibodies ? we cannto phenotype patient when recived trainsfusion every month.

[Malcolm Needs ☆]

Terri Bostock is quite correct with the tests she suggests (although haptoglobin testing is not that reliable, as some people have naturally low levels, and if the pre-transfusion level is low, but this is unkown, it can be misleading).

If the patient has an underlying haemolytic pathology, such as sickle cell disease or thalassaemia, or a haemolytic anaemia, then the bilirubin and the serum LDH could be higher than normal, but this would not be (enirely) due to a delayed haemolytic transfusion reaction.

If there is marked decrease in the period between the need for a transfusion, then there is a fair chance that there maybe a de novo unidentifed antibody present. This may not be reflected with frank haemoglobinurea.

I am going to make a statement here for which I have no justification in your case, but have you thought about looking for an anti-Doa or anti-Dob? These nasty little antibodies rear their ugly heads quite often as an extra antibody in a mixture (it is quite rare to find them on their own), can cause delayed haemolytic transfusion reactions, but are rarely "strong", and can be easily missed.

:idea::idea:

[newBB]

Terri Bostock is quite correct with the tests she suggests (although haptoglobin testing is not that reliable, as some people have naturally low levels, and if the pre-transfusion level is low, but this is unkown, it can be misleading).

If the patient has an underlying haemolytic pathology, such as sickle cell disease or thalassaemia, or a haemolytic anaemia, then the bilirubin and the serum LDH could be higher than normal, but this would not be (enirely) due to a delayed haemolytic transfusion reaction.

If there is marked decrease in the period between the need for a transfusion, then there is a fair chance that there maybe a de novo unidentifed antibody present. This may not be reflected with frank haemoglobinurea.

I am going to make a statement here for which I have no justification in your case, but have you thought about looking for an anti-Doa or anti-Dob? These nasty little antibodies rear their ugly heads quite often as an extra antibody in a mixture (it is quite rare to find them on their own), can cause delayed haemolytic transfusion reactions, but are rarely "strong", and can be easily missed.

:idea::idea:

i have some update the patient i mentioned having GI bleeding after i asked the physician.

[Malcolm Needs ☆]

i have some update the patient i mentioned having GI bleeding after i asked the physician.

Once again, this diagnosis can have many causes, including carcinoma of the bowel, that can lead to occult bleeding and then frank bleeding, both of which could lead to chronic anaenia and, eventually, an acute bleed leading to acute blood loss. Unfortunately, such a medical diagnosis does nothing to help you to decide whether there is a delayed haemolytic transfusion reaction or not (although, if there is frank blood loss, rather than a haemolytic anaemia, the serum LDH level, as suggested by Terri Bostock, could well help in your own diagnosis; it would tend to be normal with a bleed, but higher with a bleed accompanied by a delayed HTR).