A 72-year-old female with co-morbidities posted for surgical correction of fracture neck of femur without any history of transfusions was noted to have a hemoglobin level of 7 g/dl and packed red blood cells transfusion was ordered. Pretransfusion tests demonstrated A1B group with D positive on forward grouping. Reverse grouping showed a varying grade of agglutination with A, B, and O cells. Agglutination being stronger at 4°C. Antibody screening showed pan-agglutination, direct Coomb's test and auto control were negative. The serum reacted with adult O cells (OIadult) but not with adult Bombay cells (Oh Iadult) or O cord (Oicord) cells. A possibility of a compound cold antibody anti IH was made and A1B compatible cells were transfused to the patient. This case report illustrates anti-IH cold agglutinin with broad thermal amplitude. Uniqueness of this case report was O group incompatibility with A1B group, which was detected earlier and a catastrophic transfusion reaction being subverted.
Background: ABO grouping, Rh typing and crossmatching are routinely done as part of pre-transfusion testing. The Type and Screen (T&S) protocol has been used in developed countries to ensure the survival of transfused red cells. In this study, we compared the safety, costs and turnaround times (TATs) of the T&S protocol and the conventional pre-transfusion testing protocol for patients who had been scheduled for elective obstetrical or gynaecological procedures. Methods: This observational study was conducted in three phases at the Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Kerala, India and involved 1,800 patients from the Department of Obstetrics and Gynaecology, Jubilee Mission Medical College & Research Institute, Kerala, India over the course of 2 years. Phase I involved the traditional pre-transfusion testing and crossmatching of 150 patients. Phase II involved the use of the T&S protocol on 150 patients. Phase III involved the use of both the traditional and T&S protocols on 1,500 patients without considering the results of each protocol. The safety, costs and TATs of both protocols were compared. Results: In this study, the T&S protocol provided a safety 100% level when compared to the traditional protocol. The T&S protocol detected unexpected antibodies in 0.4% of cases, which would have gone unnoticed otherwise, demonstrating its usefulness. There was no significant difference in cost between the traditional crossmatching and T&S protocols. We discovered that using only the T&S protocol can save technologists 30% of their time. Conclusion: Implementing the T&S protocol as a pre-transfusion testing procedure can help improve hospital transfusion practices by supplying blood quickly and safely. Coombs cross-matching remains more of a tradition than a necessity.
A 31-year-old primigravida at 33 weeks of gestation with precious twin pregnancy was referred from a peripheral hospital with jaundice, malaise and hypoglycaemia. A clinical diagnosis of acute fatty liver of pregnancy progressing to coagulopathy was made. Emergency Caesarean section was performed and obstetric hysterectomy had to be done to control the bleeding. Timely management by obstetrician, anaesthetist and prompt component therapy by transfusion medicine specialist resulted in a successful outcome. The most advocated ratio of transfusing blood products in massive transfusion is 1:1:1 (packed red cells: fresh frozen plasma: platelets).
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