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Red cell exchange to mitigate a delayed hemolytic transfusion reaction in a patient transfused with incompatible red blood cells
Author(s) -
Irani Mehraboon S.,
Karafin Matthew S.,
Ernster Luke
Publication year - 2017
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21461
Subject(s) - medicine , red cell , red blood cell , blood transfusion , antigen , cirrhosis , immunology , exchange transfusion , antibody , gastroenterology , surgery
Purpose A red cell exchange was performed to prevent a potentially fatal hemolytic transfusion reaction in a patient with anti‐e who was transfused with e‐antigen unscreened red blood cells during liver transplant surgery. Case Report A 64‐year‐old woman with cirrhosis due to hepatitis C was scheduled to receive a liver transplant. She had a previously documented anti‐e, an antibody to the Rh(e)‐antigen that is known to cause delayed hemolytic transfusion reactions. Pre‐operatively and intra‐operatively, she had massive hemorrhage which required transfusion of 34 e‐antigen unscreened red blood cells (RBCs) most of which were incompatible. The hemoglobin dropped from 9.1 g/dL on post‐operative day (POD)1 to 6.6 g/dL on POD6, with no evidence of blood loss. The bilirubin also increased from 5.0 mg/dL on POD 1 to 11.0 mg/dL on POD 6. As she was also becoming more hemodynamically unstable, a red cell exchange with 10 units of e‐negative RBCs was performed on POD 6. She improved clinically and was extubated the following day. A few residual transfused e‐positive red cells were detected after the red cell exchange until POD 13. Conclusion This case illustrates how a red cell exchange can mitigate the potentially harmful effects of a delayed hemolytic transfusion reaction caused by red cell antibodies. With massive intraoperative blood loss it may not be possible to have antigen‐negative RBCs immediately available, particularly for the e‐antigen, which is present in 98% of the donor population. The ability to perform such a procedure may be life‐saving in such patients. J. Clin. Apheresis 32:59–61, 2017. © 2016 Wiley Periodicals, Inc.