DOGLOVER Posted December 20, 2013 Share Posted December 20, 2013 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. Link to comment Share on other sites More sharing options...
Eagle Eye Posted December 20, 2013 Share Posted December 20, 2013 (edited) 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 gelPlease update us on your findings Edited December 22, 2013 by Eagle Eye Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 20, 2013 Share Posted December 20, 2013 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. John Eggington 1 Link to comment Share on other sites More sharing options...
Yanxia Posted December 22, 2013 Share Posted December 22, 2013 What about the ABO type, is it compatible. I know this kind of thing sounds imposibble to happen. Link to comment Share on other sites More sharing options...
galvania Posted December 23, 2013 Share Posted December 23, 2013 Check also - any signs of sepsis? Is he on one of the nasty antibiotics? Has he also received FFP? Any antibodies in the FFP? Link to comment Share on other sites More sharing options...
DOGLOVER Posted December 24, 2013 Author Share Posted December 24, 2013 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. Malcolm Needs 1 Link to comment Share on other sites More sharing options...
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