Chapter 17( Immunohematology and Transfusion Medicine)
A 17-year-old man is admitted with multiple injuriesafter his motorcycle crashes. The emergency department physiciandraws a blood sample for a STAT type and crossmatch. Themotorcyclist's passenger also has blood drawn for a STAT type andscreen. An immediate-spin crossmatch is compatible between thegroup A patient and group A donor. The unit of blood is issued fromthe blood bank as an emergency release. After receiving 50 mL ofthe first unit of RBCs, the man develops shaking chills and becomeshypotensive with a falling blood pressure. The unit of cells isimmediately discontinued, and the transfusion service is notifiedof the situation. A recheck of testing is requestedimmediately.
Laboratory Testing Clerical check:
No evidence of clerical errors
Hemoglobinemia: Slight hemolysisobserved
Direct antiglobulin test
Patient pretransfusion: Negative
Patient posttransfusion: Weaklypositive
Recheck of blood grouping
pretransfusion: A positive Patient
posttransfusion: O positive
Donor: A positive
Repeat crossmatches
Patient pretransfusion + Donor red blood cells =Compatible
posttransfusion + Donor red blood cells =Incompatible
Critical Thinking Group Discussion
1. Why did this patient experience shaking chills and otheradverse effects after receiving only 50 mL of red blood cells?
2. If the patient's adverse reaction to the blood transfusionhad not been noted soon after the beginning of the transfusion,what physiologic changes would have occurred to the patient?
