Status:
Ready to upload
Record number:
1223
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
The rate of adverse reactions to apheresis is low in comparison to the morbidity of DHTRs. Adverse reactions during apheresis are typically mild and reported in less than 5% of procedures, whereas more than 60% of DHTRs are associated with mild to severe morbidity. In fact, major morbidity has been observed in greater than 10% of DHTRs.
Time to detection:
6 days
Alerting signals, symptoms, evidence of occurrence:
Following transfusion of 12 RBC units, a family member's comments led to the discovery of a patient's history of 4 alloantibodies (anti-E, anti-c, anti-Fya, and anti-M). Testing revealed that all 12 units were incompatible for at least 1 antigen. Six days after transfusion, the patient developed a newly positive antibody screening and direct antiglobulist test (DAT) result. To prevent further hemolysis, automated red cell exchange (ARE) was performed to replace incompatible RBCs with antigen-negative units.
Demonstration of imputability or root cause:
A newly positive antibody screen and direct antiglobulin test (DAT) result was obtained 6 days after the incompatible transfusion.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
"DHTR, red blood cell exchange, alloimmunization"
anti-E, c, Fy(a), M
Reference attachment:
Suggest references:
Tormey, C.A. and Stack, G. (2013). Limiting the extent of a delayed hemolytic transfusion reaction with automated red blood cell exchange. Arch Pathol Lab 137(6):861-864.
Expert comments for publication:
There are 3 reports in which ARE was used to treat severe DHTR. In the two previous publications was performed after the reactions had already progressed to renal failure and hemodynamic instability. The present article is the first in which ARE was used to prevent a DHTR.