CAP Compliance Consensus Conference 6-7-13

Case #1 54 year old man with multiple gunshot wounds. Presents to OSH and get 1 unit of Rh- RBCs. Presents to Vanderbilt and receives 2 units of Rh+ trauma blood

Case #1 A specimen is sent to the blood bank

Case #1 The DAT is + for IgG (2+) but negative for complement. Elution identifies anti-D Antibody screen identifies anti-D Pre Transfusion Post Transfusion HgB 9.3 9.5 Urine color Yellow Dark Red Potassium 4.4 4.9 -> 6.8 Anti-D titer 1:128 1:8192

Case #2 Round Wing Nurse: "I can't remember what it is - do you hang platelets or ffp by gravity? I know it is one or the other, but I can't remember which one".

Case #2 Patient is post operative day 2 from a removal of a peritoneal mass anterior to the bladder. Patient has an epidural catheter but good pain control so they want to pull it. Anesthesia wants plt>80 to remove the catheter. Pt count: 76 Hospital low on plts. Recommended repeat CBC. Plt count was 84. Catheter pulled without incident and without transfusion.

Case #3 61 year old white male with a history of coronary artery disease, diabetes, high blood pressure, chronic renal insufficiency and hyperlipidemia admitted for management of chest pain. He has received several transfusions in 2011 at Vanderbilt. His blood type is O, Rh+

Case #3 An antibody screen was performed and was positive. To follow up the positive screening test, the patient's plasma was tested against a panel of reagent red blood cells and an anti-E and an anti-Fyb were identified. In addition, the pattern of reactivity was consistent with an anti-D. Monoclonal blood grouping reagents typically will identify these patients as Rh negative (ab is to domain VI), but it depends on which domain is missing. Possibly a case of anti-Lw.

Case #4 20F involved in rollover motor vehicle collision. Comes to the hospital and has a positive antibody screen, with an anti-D detected. Her DAT was negative. Anti-D Titer was 2. She is transfused 2u of Rh+ trauma blood Post transfusion, she has normal LDH, total bilirubin. Type and screen shows mixed field reaction on forward screen, but her screen is now negative.

Case #4 Pre RhIg Post RhIg HgB 10.8 LDH 213 174 -> 406 3-4 Weeks ago had a lost pregnancy, was given RhIg at an outside hospital. To prevent alloimmunization, 48 vials of rhophylac were given (within the 72 hour window) IV in the SICU. After the first dose, her DAT was 3+/mf positive for IgG, negative for complement. She had an episode of tachycardia, hypotension and tachypnea but serology was negative for hemolysis and further doses were well tolerated. Pre RhIg Post RhIg HgB 10.8 12.6->11->11.6->11.1->10.8->10.7 LDH 213 174 -> 406 Hemoglobinemia None Anti-D titer 256