Emergency transfusion of incompatible red blood cells.
Article Type: Letter to the editor
Authors: Ong, Menchu G.
Ezidiegwu, Christian
Beadling, Wendy
Rosales, Lazaro G.
Pub Date: 09/01/2008
Publication: Name: Archives of Pathology & Laboratory Medicine Publisher: College of American Pathologists Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2008 College of American Pathologists ISSN: 1543-2165
Issue: Date: Sept, 2008 Source Volume: 132 Source Issue: 9
Accession Number: 230247136
Full Text: To the Editor.--In the October 2007 issue of the Archives, Johnson et al (1) reported the case of a 62-year-old woman who developed anti-U following the transfusion of 2 units of red blood cells. Subsequently, she developed life-threatening gastrointestinal hemorrhage requiring further transfusion. At that time, her serum antibody reacted with all the reagent red blood cells in the antibody identification panel, and no compatible blood was available. This patient was successfully transfused with cross-match-incompatible red blood cells after pretransfusion medication with methylprednisolone.

We report a similar case of a 51-year-old woman who developed anti-Lub and anti-E following multiple transfusions for coronary artery bypass surgery. Two weeks following the surgery, this patient developed severe anemia (hematocrit, 16%) from menorrhagia and was readmitted to our hospital for hysterectomy. Preoperatively, she received 4 units of Lub untyped, E-negative, least-incompatible, leukoreduced red cells, with 25 mg diphenhydramine and 650 mg acetaminophen orally as pretransfusion medications. The units were given per our in vivo crossmatch protocol, as follows: infuse the first 30 mL of each unit slowly, observe the patient's clinical response, and obtain a 30-minute sample for testing to exclude hemolysis. All of the units were successfully infused, with no untoward effects. She subsequently had successful surgery, with 1 additional Lub antigen-incompatible unit transfused intraoperatively.

Anti-Lub is not often encountered, and it is most often produced in response to pregnancy or transfusion, but it has occurred in the absence of obvious red cell stimulation. It has been reported to cause shortened survival of transfused red cells, but it causes no, or at most very mild, hemolytic disease of the fetus and newborn. (2) Because the antigen is of high frequency, finding compatible units is often difficult, and least-incompatible units may have to be transfused where warranted due to the patient's clinical condition. Other patients who may benefit from the in vivo cross-match strategy are those with autoantibodies or antibodies with multiple specificities. As shown by our experience with this patient, depending on the alloantibody, transfusion of least-incompatible units does not always result in immediate hemolysis, and the incompatible cells may remain in the circulation long enough to provide therapeutic benefit. (3)

Menchu G. Ong, MD

Christian Ezidiegwu, MD

Wendy Beadling, MT(ASCP)SBB

Lazaro G. Rosales, MD

Department of Pathology

SUNY-Upstate Medical University

Syracuse, NY 13210

(1.) Johnson V, Langeberg A, Ahmad M, Sandler SG. Emergency transfusion of incompatible red blood cells [letter]. Arch Pathol Lab Med. 2007; 131:1514-1515.

(2.) Brecher ME, Combs MR, Drew MJ, et al. AABB Technical Manual. 14th ed. Bethesda, Md: AABB; 2002:328-329.

(3.) Mollison PL, Engelfriet CP, Contreras M. Blood Transfusion in Clinical Medicine. 10th ed. Oxford, England: Blackwell Scientific Publications; 1998.

The authors have no relevant financial interest in the products or companies described in this article.

In Reply.--We thank Ong and colleagues for bringing to our attention their case, which further confirms that not all crossmatch-incompatible red blood cell transfusions result in immediate clinical reactions and/or significantly shortened posttransfusion survival of transfused red blood cells. The intent of our letter (1) was to promote reporting of additional experiences, such as that reported by Ong et al, so that we may develop responsible policies addressing the predicament of patients whose lives depend on an urgent transfusion and a transfusion service that reports serologic incompatibility with all red blood cells. We agree that an in vivo crossmatch is one way to approach this problem.

Viviana Johnson, MD

Department of Pathology and Laboratory Medicine

National Naval Medical Center

Bethesda, MD 20889

S. Gerald Sandler, MD

Department of Laboratory Medicine

Georgetown University Hospital

Washington, DC 20007

(1.) Johnson V, Langeberg A, Ahmad M, Sandler SG. Emergency transfusion of incompatible red blood cells [letter]. Arch Pathol Lab Med. 2007; 131:1514-1515.

The views expressed in this letter to the editor are of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government.

The authors have no relevant financial interest in the products or companies described in this article.
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