A 60-year-old woman with anemia is admitted to the hospital. Her hematocrit is 1

Question

A 60-year-old woman with anemia is admitted to the hospital. Her hematocrit is 17% and she has been experiencing subtle gastrointestinal bleeding over many weeks. Her physician requests 4 units of red blood cells for transfusion. The patient’s RBCs phenotyped as group AB, D-positive. Her antibody screen is negative on the sample drawn in the emergency room, but her records indicate a previously detected anti-E. Only three group AB, D-positive red blood cell units are available in the blood bank’s inventory. The blood bank’s inventory contains RBC donor units of all ABO and D types

.Additional Testing:: Having located 6 E-negative donor units, you perform crossmatching on the units. One of the units is incompatible in the antiglobulin phase (2+). The physician is becoming insistent on beginning the transfusion, since the patient is having some shortness of breath.

5. How do you respond to the physician’s request?

6. List several reasons to explain the one incompatible donor unit.

7. What additional testing do you perform?

Explanation / Answer

For the blood transfusion to be succesful,ABO and Rh group compatibility should be seen .

As this woman is of AB group, which is the universal recipient, she can recieve blood from donor of any blood group.

Now, it is given that the person has a previous history of anti-E antibodies earlier, which called for the cross matching. If this person is now given E positive blood, these antiE antibodies will act against the E antigen, which will cause agglutination or the hemolytic tranfusion reactions, which can be fatal.

But out of the six E negative units, only one was incompatible, therefore other five units are safe for transfusion.

The incompatible blood type is the only one that contains E antigen.

So, in my opinion, the transfusion should be started as soon as possible, as the hematocrit level is very low , which suggests of an emergency. Three D positive blood and one E negative blood units can be used for the transfusion.

REASONS FOR THE INCOMPATIBLE BLOOD UNIT- The possible reasons for the incompatible cross matching may be -

OTHER TESTS- Additional tests , which are done in addition to tghe cross match are -

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