Delayed Hemolytic Transfusion Reactions

Jennifer Jenkins MPH, MLS

UK Good Samaritan Hospital

Objectives

• Compare and contrast acute versus delayed transfusion reactions

• Look at the lab values associated with delayed transfusion reactions

• Discuss mixed-field reactions associated with delayed transfusion reactions

Signs/Symptoms

Acute Hemolytic Transfusion Reaction (<24 hrs post transfusion)

Delayed Hemolytic Transfusion Reaction (Usually within 3-21 days)

Fever (≥1°C or 2°F) Fever

Chills Unexplained fall in Hemoglobin

Renal Failure Renal Failure (rare)

Hemoglobinuria Hemoglobinuria

Hypotension

DIC (Disseminated Intervascular Coagulation)

Back Pain

Pain along infusion vein

Oliguria

Oozing from I.V. site/surgical incision

Laboratory tests to consider

• Direct Antiglobulin Test (DAT)

– IgG

– Complement

– Medications

• New Antibody Identified

– Eluate

– Kidd system

• Titers fall quickly

Laboratory tests to consider (cont.)

• Bilirubin – Increased due to RBC destruction

• liver disease, such as hepatitis

• hemolytic anemia

• cirrhosis, scarring of the liver

• biliary stricture, where part of the bile duct is too narrow to allow fluid to pass

• cancer of the gallbladder or pancreas

• gallstones

• drug toxicity

Laboratory tests to consider (cont.)

• LDH – Increased due to RBC destruction

• blood flow deficiency • cerebrovascular accident • certain cancers • heart attack • hemolytic anemia • infectious mononucleosis • liver disease • muscle injury • muscular dystrophy • pancreatitis • tissue death • use of alcohol or certain drugs • sepsis and septic shock

Case Study 1

• 38 year old female

• O Positive

– Received 2 units O Pos on 4/29

• New Specimen Drawn 5/11 showed Anti-Jka

– 1 Jka negative unit was given

Antibody Screen

Panel A

Panel B

Case Study 1 (cont.)

• Delayed transfusion reaction workup showed

– negative DAT

– no visible hemolysis

– one of the units the patient had received on 4/29 was Jka positive

– Reticulocyte harvest showed negative for the Jka antigen

Case Study 2

• 67 year old female

• A Neg

– Switched to Rh Positive units per pathology

• Decreasing RBCs post surgery

• Emergency uncrossmatched units ordered just after specimen expired at midnight for code

• 4 uncrossmatched units O Pos issued

Antibody Screen

Panel A

Case Study 2 (cont.)

• Antibody Screen positive

• Called to switch to O neg

– Took 12 O neg units total

• Negative DAT

• Mixed Field with D Typing

Questions?

Sources

• Fung, Mark K., Brenda J. Grossman, Christopher D. Hillyer, and Connie M. Westhoff.Technical Manual. Bethesda, MD: American Association of Blood Banks, 2014. Print.

• "Blood Bank Guy Home Page - Joe Chaffin, MD." Blood Bank Guy. N.p., n.d. Web. 17 Aug. 2017.

• Reid, M. E., Lomas-Francis, C., & Olsson, M. L. (2012). The blood group antigen. Amsterdam: Elsevier/Academic Press.