Case 36

1. Presented by Eric A. Gehrie, MD and prepared by Lorraine N. Blagg, MA, MLS(ASCP)SBB

Clinical Vignette

An adult patient with a history of malignancy presented to the emergency department with chest pain and shortness of breath. The patient had a WBC count of 1.25 K/cu mm, hemoglobin of 3.6 g/dL, hematocrit of 10.7%, and a platelet count of 9 K/cu mm. The patient typed as an O positive with a negative antibody screen. During the admission, the patient was transfused multiple units of RBCs and platelet units, and was then transferred to another institution. During that admission, the patient was nonreactive for HIV-1/2 antibody, hepatitis C antibody, hepatitis B core antibody, and hepatitis B surface antigen.

Several months later, the transfusion service is notified by their blood supplier of a unit of RBCs received by this patient where the donor is now reactive with the anti-HCV screening test, had a positive supplemental hepatitis C virus antibody test, and a nonreactive HIV-1/HCV/HBV NAT multiplex. There have been zero negative donations between the product received and the positive test result.

What action must be performed by the transfusion service?