Mismatched transfusion of 8 AB0-incompatible units of packed red blood cells in a patient with acute intermittent porphyria

Rudlof, B.; Just, Burkhard; Deitenbeck, Robert; Ehmann, Tom

doi:10.4103/1658-354x.76497

Cited by 6 publications

(3 citation statements)

References 11 publications

(13 reference statements)

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“…[2] AHTR can present as hypotension, tachycardia, increase in temperature, perspiration, flushing, rashes, bronchospasm, nausea, breathlessness, and palpitation, but in an anesthetized patient, it may present as hypotension, increase in airway pressure, hematuria, and diffuse bleeding due to disseminated intravascular coagulation (DIC) either in combination or alone. [25] In this case, the presence of hematuria was the only clue that led to the suspicion of mismatch transfusion and further evaluation in that direction. Intravascular hemolysis leads to release of Hb which is bound by haptoglobin, hemopexin, and albumin; when the binding capacity of free Hb is exhausted, it will be secreted and reabsorbed in glomeruli; when the absorptive capacity by the glomeruli is exceeded, hemoglobinuria ensues.…”

Section: Discussionmentioning

confidence: 87%

Intraoperative acute hematuria: Sole clue to mismatch transfusion

Rudingwa

Senthilnathan

Srinivasan

et al. 2019

Asian J Transfus Sci

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Hemolytic transfusion reactions (HTRs) remain one of the dreaded complications of transfusion-related morbidity and mortality. Here, we describe the diagnosis and management of acute HTR following transfusion of ABO-incompatible packed red blood cell under general anesthesia which manifested solely as acute intraoperative hematuria. A 65-year-old, diabetic male was scheduled for emergency re-explorative laparotomy in view of suspected anastomotic leak following subtotal gastrectomy. One unit of packed cell was transfused intraoperatively. Toward the end of surgery, hematuria was noted by the attending anesthesiologist, and the accidental bladder injury was ruled out by the surgeon. Transfusion of ABO-incompatible blood was spotted; direct Coombs test became positive. To mitigate the impact of incompatible blood, 1 L of 0.9% normal saline was administered. Mannitol 0.5 g/kg and furosemide 20 mg were administered every 8 th hourly, and 1 ml/kg/h of urine output was targeted. Sodium bicarbonate (7.5%) 20 meq was administered intravenously to alkalinize the urine.

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Section: Discussionmentioning

confidence: 87%

Intraoperative acute hematuria: Sole clue to mismatch transfusion

Rudingwa

Senthilnathan

Srinivasan

et al. 2019

Asian J Transfus Sci

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“…An ABO incompatible red blood cells transfusion is a leading cause of death from transfusion. 5 The subgroup typing is usually carried out when there is a discrepancy in blood group typing based on adsorptions elution studies, presence of A, B, H substances in the saliva and family studies. Moreover, ABO discrepancies may also be resolved using patient's age, diagnosis, medication, history of pregnancy, or recent transfusion.…”

Section: Discussionmentioning

confidence: 99%

Study of discrepancies in ABO blood grouping: experience of a tertiary health-care center

Nathani

Patel

et al. 2021

Int J Res Med Sci

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Background: An accurate ABO grouping is the most important test which is done in the blood bank. Mistyping can lead to transfusion with ABO incompatible blood which results in severe intravascular haemolysis and may even result in the death of the recipient. An ABO discrepancy implies that the forward or red cell ABO grouping does not agree with the reverse or serum ABO grouping. The study was conducted to evaluate the frequency of ABO blood group discrepancies, to identified main causes of discrepancies, to avoid chances of wrong interpretation of blood group and to mitigate clinical impact associated with mismatch ABO transfusion.Methods: A prospective study of ABO discrepancies and their causes was performed on 25,129 samples of the patients and 13,251 samples of blood donors at the red cell serology laboratory in tertiary care teaching hospital and blood bank over the period from February 2017 to July 2018.Results: ABO group discrepancies were mainly divided in 4 different groups. Out of 51 discrepancies 32 (62.74%) were found in group-IV category, being highest amongst all; 10 (19.60%) in group-II which was second highest; other were 8 (15.69%) in group-I and 1 (1.96%) in group-III category.Conclusions: All discrepancies reported on ABO cell and serum grouping must be investigated further, so that correct blood group is reported, minimizing the chances of transfusion reaction. A note of caution should be mentioned on the blood group card to prevent ABO incompatibility in case of transfusion.

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“…Because of blood grouping, transfusion requires mandatory matching between blood donor and receptor to avoid any possibility of antigen–antibody response that would induce an immune-hemolytic reaction . However, although transfusion laboratories perform highly reliable matching tests, mismatching can still occur (5.0 to 5.2 mismatches per 100 000 transfusions); even if this inconvenience is prevented by the use of type O RBCs, supplies of these cells are usually insufficient in hospitals . To sort out this lack of universal RBCs, cell surface modification has become a promising strategy for production of silent RBCs. , …”

Section: Introductionmentioning

confidence: 99%

Poly(2-dimethylamino ethylmethacrylate)-Based Polymers To Camouflage Red Blood Cell Antigens

et al. 2012

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Poly(2-dimethylamino-ethylmethacrylate) (PDMAEMA) is a cationic polymer when dissolved in a 7.4 pH fluid.Owing to its ionic nature, this polycation interacts with the negatively charged cell membrane surface of red blood cells (RBCs). The electrostatic self-assembly of PDMAEMA on RBCs membrane can be employed for inducing the formation of a polymeric shield camouflaging blood group antigens on RBCs as a valuable strategy for developing "universal RBCs" for blood transfusion. The purpose of this research was to evaluate the camouflaging ability of PDMAEMA homopolymers and PDMAEMA-copoly(ethylene glycol) copolymers differing in molecular weight and architecture. Surprisingly, the PDMAEMAs caused a partially masking, no masking, and sensitization of the same RBCs population. The MW and architecture of the polymers as well as temperature of PDMAEMA-RBCs treatment influenced the results observed. Herein, the very particular reactivity of PDMAEMAs and RBCs is analyzed and discussed.

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Mismatched transfusion of 8 AB0-incompatible units of packed red blood cells in a patient with acute intermittent porphyria

Cited by 6 publications

References 11 publications

Intraoperative acute hematuria: Sole clue to mismatch transfusion

Intraoperative acute hematuria: Sole clue to mismatch transfusion

Study of discrepancies in ABO blood grouping: experience of a tertiary health-care center

Poly(2-dimethylamino ethylmethacrylate)-Based Polymers To Camouflage Red Blood Cell Antigens

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