delayed hemolysis

[DOGLOVER]

Any thoughts: Have a patient who had a 10 unit red cell exchange 3 days ago without incident. He is now hemolyzing with a hemoglobin drop of 5-6 grams/dl. LDH has jumped to over 3000. Platelets are low. Antibody screen is negative in gel, negative in PEG using polyspecific Cooms.(also neg at room temp). Dat is neg both pre and post using tube and gel testing.enzyme screen is also neg. Any ideas as to what is going on? Thanks everyone.

[Eagle Eye]

Is this sickle cell patient? May be hyperhemolysis?

1) Perform extended cross match with post specimen and those 10 units.

2) Run panel by gel, use the one which had low frequency antigen on it

There is a paper somewhere anti-kpa causing hemolytic tx?

3)Perform eluate and run by tube & if negative by gel

Please update us on your findings

Edited December 22, 2013 by Eagle Eye

[Malcolm Needs ☆]

Almost certainly hyperhaemolysis if the patient's Hb ends up lower than before the transfusion was given.

DO NOT TRANSFUSE FURTHER UNLESS THE ANAEMIA BECOMES LIFE THREATENING.

If further transfusion is needed, give high dose IVIG and methylprednisolone, and cross your fingers.

Read many papers by Win N.

[Yanxia]

_{What about the ABO type, is it compatible. I know this kind of thing  sounds imposibble to happen.}

[galvania]

Check also - any signs of sepsis?  Is he on one of the nasty antibiotics?  Has he also received FFP?  Any antibodies in the FFP?

[DOGLOVER]

After I brought up the idea of hyperhemolysis, our medical director got with the hem-onc doc and they decidedd that is what it has to be. He is being treated with plasma exchange and I don't know what else. I hope he doesn't have another sickle crisis anytime soon. Thanks for all your input. Merry Christmas everyone.