Transfusion Reaction Workup

[jojo808]

Just curious on how many of you do a post-transfusion workup with a urine collection and how do you differentiate hematuria from hemoglobinuria? We do the following which I believe most of us do:

 

1.  Clerical checks.

2.  Check concentration of Saline Solution that is usually piggy backed to the donor unit.

3.  Draw Post-transfusion EDTA to check for hemolysis and DAT ( if DAT is pos, we test pre-transfusion specimen).

4.   ABO/RH recheck on donor units.

 

We also do a dipstick and microscopic on a urine specimen and need to notify a pathologist if it is Positive for blood which it usually is: maybe 0-2/hpf on the microscopic and maybe trace on the dipstick. We usually don't have a pre-transfusion UA to compare with but even if we did most of us don't feel comfortable calling a pathologist at 2am with those kinds of results. I don't think we should notify a pathologist unless the supernatant of the SPUN down urine is bright red ... but that's me, what do you guys think???

 

 

 

[David Saikin]

We dipstick the urine - if positive for blood we will do a microscopic: rbcs are of no concern, hemoglobinuria will send us to the next level of investigation.

[mollyredone]

_{Initially we do clerical check, and check on pre and post transfusion specimens for hemolysis, icterus, DAT and type.  We only request a urine specimen if any of the previous results are positive.}

 

_{edited because the font was so small!}

Edited September 17, 2014 by mollyredone

[SMILLER]

Pretty much the same here as Molly, above.  We would run a serum haptoglobin, plasma hemoglobin, and urine for Hgb only if we were sure it was NOT just a febrile reaction.  Here, a urine Hgb is done by testing a strip on the spun supernatant.

 

Scott

[aafrin]

Same as Molly and Smiller above. We don't do DAT if it is just a febrile reaction - possible etiology FNHTR.

[Dansket]

Our STAT investigation for any reported Adverse Reaction to Blood Transfusion includes pre/post DAT, pre/post ABO/Rh, Clerical Check and Visual Inspection for hemolysis. No further testing is done if all findings are 'negative'. Post-reaction urine is collected but no testing done unless there is a positive finding in the STAT investigation.

[Eoin]

Same as Dankset.

First void collected and kept - examined for haemoglobinuria & bilirubinuria only if other work-up is positive. Would be looking at Haptoglobins then as well.

 

Cheers

Eoin

[L106]

We dipstick the urine - if positive for blood we will do a microscopic: rbcs are of no concern, hemoglobinuria will send us to the next level of investigation.

This is what we do, too.

 

Donna

[Dansket]

Between Donna and David, would you tell us out of the last 100 workups you did, under what circumstances did a finding of hemoglobinuria ( in the absence of no other finding) lead to the discovery of an incompatible blood transfusion due to an previously undetected red cell antibody?

 

In other words, what am I missing by not doing what you do?

Edited October 15, 2014 by Dansket

[Auntie-D]

Between Donna and David, would you tell us out of the last 100 workups you did, under what circumstances did a finding of hemoglobinuria ( in the absence of no other finding) lead to the discovery of an incompatible blood transfusion due to an previously undetected red cell antibody?

 

In other words, what am I missing by not doing what you do?

 

We only dipstick and do all the 'other' chemistry tests if there is an incompatibility found.

[LIMPER55]

we do the same  --except---

would you perform the eluate on a patient with a positve DAT  IF

he only received FFP?