Case 137

1. Prepared by Diana Fang, MD and reviewed by Herleen Rai, MD.

A middle-aged patient with a history of multiple myeloma is in the hospital for chemotherapy. They started their current regimen two weeks ago. They are hemodynamically stable and tolerate treatment. The inpatient team orders a type and screen for a red cell transfusion for a hemoglobin of 5.9 g/dL. The patient’s blood bank workup revealed a positive antibody screen with 1+ panreactivity.  Of note, a previous workup demonstrated an antibody reactive at the antihuman globulin phase that neutralized with pooled human plasma. No new antibodies were identified to red blood cell antigens after testing with dithiothreitol (DTT)- treated RBCs and neutralized plasma. Their blood type is A+. All potential red cell units are crossmatch incompatible.

Question: What is your next step? ​