Case 103 – update 2

We think our patient may have had an intravascular haemolytic transfusion reaction, although our negative investigations so far are unusual.

The patient’s Hb is now around 55g/l. The creatinine is now around 500umol/l. Bilirubin is now 20 and haemoglobinuria resolves a day following the last transfusion. The patient is breathless when she walks around the hospital ward with occasional dizzy episodes. As a result of the chemotherapy her retic response has been poor therefore there has not been the expected rise in Hb. She is is overdue her next cycle of chemotherapy, however this has been suspended currently.

The patient is group O RhD+, the transfused units have been checked and are also ORhD+

So far our results have shown:

Haptoglobins – undetectable

LDH raised

Retics reduced

Haemoglobinura – confirmed

Samples have been sent to NHSBT for further investigations.

On pre and post transfusion samples:-

DAT negative (IgG, IgM,IgA,C3c,C3d)

Eluate against panel negative

Serum and plasma antibody panals on all samples

IAT – Negative

Enzyme IAT – Negative

IAT anti IgA – Negative

LISS tube – Negative

Polyethylene glycol – Negative

We have arranged to phenotype the patient’s pre transfusion sample and the transfused red cells.

What do these show?

What is the most likely antibody?

Are there any other investigations we could consider?

Are there any other clinical measures we can consider for our patient?

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