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???

 

 

 

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.

_{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, 201410 yr by mollyredone

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

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

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.

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

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

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, 201410 yr by 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?

 

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

we do the same  --except---

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

he only received FFP?