Case 76 | Clinical Pathology Unknown Conference

1. Prepared by Alice Meiss, MD
Reviewed by Lorraine N. Blagg, MA, MLS(ASCP)CMSBB

An adult with a history of hematologic malignancy, currently undergoing treatment, is seen in clinic. They have received multiple RBC and platelet transfusions over the past few weeks. Their labs show a hemoglobin of 6.7 g/dL and a platelet count of 8 K/mm^3. They are pre-medicated with diphenhydramine and acetaminophen then transfused with one unit of A positive RBCs followed by two units of group O platelets. Their pre-transfusion temperature was 36.5 C and post-transfusion temperature is 38.0 C with other vital signs being within normal limits and no other reported signs or symptoms. You are contacted about a possible transfusion reaction with the following blood bank work-up:

Clerical check is correct.

Gram stain and culture RBC: Negative, no growth
Gram stain and culture, platelet unit 1: Negative, no growth
Gram stain and culture, platelet unit 2: Negative, no growth
Additional labs were obtained showing:
Post-transfusion hemoglobin: 7.6 g/dL
Post-transfusion total bilirubin: 0.7 mg/dL
Urinalysis showed 2 RBCs per HPF and was otherwise unremarkable

Question
What is your clinical impression of this suspected transfusion reaction?

A.) Febrile non-hemolytic transfusion reaction with a new passive anti-A1 antibody due to transfusion of group O platelets.

B.) Febrile non-hemolytic transfusion reaction. A passive anti-A1 antibody was present prior to the reaction and did not contribute to this event.

C.) Delayed hemolytic transfusion reaction due passive anti-A1 antibody from transfusion of group O platelets.

D.) Acute hemolytic transfusion reaction due to passive anti-A1 antibody from transfusion of group O platelets.

E.) No evidence of a transfusion reaction.

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11 thoughts on “Case 76”

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