75 Problem Solving Exercise on Transfusion Reactions
This exercise is to enhance testing and work performed in the student labs. Exercises are not compulsory but students are encouraged to complete the exercises and then request an answer key from the instructor to keep on track with their learning. If students find they are having difficulty with any exercise they can request additional help from the instructor.
A 65 year old man was transfused with 2 units of red blood cells 1 week ago after a revision of a previous total hip arthroplasty. Results of pre-transfusion compatibility testing at that time were unremarkable. Today, the patient’s hemoglobin is 81g/L. The physician has ordered 2 units of red blood cells for transfusion as soon as possible. The new sample reveals the following results:
ABO/Rh Typing
| Anti-A | Anti-B | Anti-D | Rh Control | A1 | B cell |
|---|---|---|---|---|---|
| 0 | 0 | 3+ | 0 | 4+ | 4+ |
Antibody Screen
| IS | 37 Degrees | AHG | CCC | ||
|---|---|---|---|---|---|
| I | R1R1 | 0 | 0 | 0 | √ |
| II | R2R2 | 0 | 0 | 0 | √ |
| III | rr | 0 | 0 | 0 | Not tested |
The results of a group O red blood cell panel are given on the next page. Please answer the following questions using the patient results.
- Does the patient’s history suggest a possible cause for the serologic difficulty?
- What antibody(ies) is/are present?
- What antibody(ies) cannot be ruled out?
- What selected cells are necessary?
- What is the significance of the enzyme testing?
- What is the reason for the variation in reaction strength?
- What is the significance of the positive autocontrol seen in the panel?
