How do we follow up on a patient who came onto the ER requiring uncrossmatched emergency? Antibody screen turned out positive. ID was Anti Jka. 1 of the 2 units given before ID was Jka positive.

This is clinical problem, rather than a technical problem, but one thing that must be done is to give lots of fluids and diuretics to keep the kidneys going.

Thank you.

Actually I am wondering from the blood bank perspective. Jka displays as delayed transfusion reaction I believe. So should we be testin h&h, billiruben? How far out?

What type follow up tests & what time period?

Not sure how Well versed or pro active medical director will be. We r small hospital without much experience with positive trans reaction ( mostly febril )

Ah, my apologies.

Yes, you are absolutely correct, but the delayed type is usually when the anti-Jka cannot be detected in the pre-transfusion sample (an anamnestic response).

In this case, the reaction could be quite quick, and you should most definitely be monitoring the patient's Hb, bilirubin, haptoglobins, serum LDH, etc from the start, and keep doing this on a regular basis for about 12 days, and Chemistry should be keeping a check on the creatine during this time.

It might just be worthwhile performing a DAT on a regular basis too, which may show how quickly the unit is being cleared frm the circulation and, to square the circle, any increase in antibody titre.

Thank you.

This has happened to us before and we contact the physician immediately so that he/she can start any treatment that may be necessary. Then Blood Bank swings into action and performs a transfusion reaction workup, following the patient for the next few days monitoring as Malcolm mentioned.

:hooray::peaceman::wave::wave:

and depends on which STATE you are in, you may need to report this to your regulatory agency not as an error but an incident as patient received antigen positive, incompatible blood.

NJ STATE requires this.

Well, they may be in quite a state over this--but maybe not New Jersey. Let us know how this comes out. The fact that you are reporting your serological findings rather than the patient's reaction symptoms suggests to me that the patient tolerated the transfusion better than we usually expect of anti-Jka. A little case study listing the patient's condition, how fast they were bleeding (if so), signs & symptoms during transfusion and after, serological results and all lab values would be really beneficial to many of us and to the literature in general. If you are not comfortable writing it up and submitting it to journals maybe someone on here could help you. Or at least post it here as an attachment for all of us to learn from (redacting identifiers, of course). No one is ever going to give Jka pos blood to a patient with the antibody on purpose so we need to gather data from inadvertent transfusions.

This case also could help us explain to MDs that giving uncrossmatched blood is sometimes the most reasonable choice rather than letting an exsanguinating patient wait or calling the lab to yell at the BB tech in hopes that will alter the laws of chemistry and biology so the testing will be done sooner.