38 years old , female for C/S request for 4 units blood 

By wrong way from technition give 4 units B+ Packed RBCs unfortunately the patient was A+ in the fact but the technetion was made x matching with the other sample which was belonged other patient 

The doctors told that the patient has taken approximately 2 units B+ blood ! 

What may occurs with patient and what the suitable steps for blood bank to save the patient .

I assume the clinical pathologist has been notified of this sentinel event?  They should be involved in the management of the patient and subsequent reporting to appropriate agencies.  

the patient still a life she did not die i ask can we give her O + PRBCs and AB + Plasma or we should give her the same main group A +?

 

I would advise A+, BUT, I am not a doctor.

On 12/1/2016 at 7:14 PM, emadlabs said:

38 years old , female for C/S request for 4 units blood 

By wrong way from technition give 4 units B+ Packed RBCs unfortunately the patient was A+ in the fact but the technetion was made x matching with the other sample which was belonged other patient 

The doctors told that the patient has taken approximately 2 units B+ blood ! 

What may occurs with patient and what the suitable steps for blood bank to save the patient .

So how is the patient?   Did she have any immediate transfusion reaction symptoms?

It would be interesting to note if the patient had received a large volume of crystalloid/colloid.  I've seen a non-B pt receive significant volumes of B red cells and survive for a few days (since their anti-B got diluted by fluids).  However massive hemolysis occurred around day 5 culminating in the demise of the patient. 

Yes, I've seen similar - A pts rarely tolerate B cells.  Oddly enough, I've seen a B pt tolerate 2 units of A just fine. 

I agree that for now support with O cells and AB plasma.  And maybe a red cell exchange.  2 units are a lot to clear.

unfortunately the patient die after 19 days in icu

 

Thanks for the sad update emadlabs.

So sorry to hear.

On Thursday, December 29, 2016 at 8:35 AM, kate murphy said:

I agree that for now support with O cells and AB plasma.  And maybe a red cell exchange.  2 units are a lot to clear.

When wrong blood, wrong tube events are identified and the patient has already been transfused; what (other) different methods can doctors use to manage and treat this type of scenario? How quickly must they be implemented and how successful are the outcomes?

Clinical management of the patient can be tricky - and sometimes no matter what's done, there's not a good outcome.

We advise following liver function and renal functions.  Much depends on if the potential Ag/Ab reaction causes intravascular hemolysis.  We'd particularly watch LDH and creat.  We may recommend hydration/Lasix to keep those kidneys flushed.  If hemolysis is severe, and LDH is high, we may recommend a red cell exchange.  Which may or may not help.  By the time you're seeing brisk hemolysis, most of the donor cells have been destroyed and there's little to exchange.  Plasma exchange is also an option.

But many times in an ABO mismatch, these things can happen quickly.  The sooner the BB med director knows, the sooner he/she can help guide clinical management.

Thank you Kate.

What needs to happen now is a thorough investigation of WHY this issue happened - not to apportion blame, but to ensure that it can never happen again due to an error in the lab