Delayed transfusion reaction associated with multiple antibodies

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Technical improvements and special training of blood bank personnel have led to decreasing frequency of transfusion reactions, and most hemolytic reactions are now preventable. However, certain blood group incompatibilities not detectable before transfusion can be responsible for delayed destruction of transfused erythrocytes. Rarely such reactions can be severe enough to induce life threatening sequelae. It is generally not appreciated that a major transfusion reaction can occur without incompatibility being demonstrated either before or immediately after transfusion. This report is an example of such a problem.

Case report

A 59-year-old woman was admitted for total left hip reconstruction on September 24, 1973. In 1959 a right hip cup arthroplasty was performed and during the operation she had received several blood transfusions. Her only delivery had been by abdominal caesarean section because of a large fetus about 30 years before, and at that time she had several transfusions. The baby was born jaundiced, but the patient did not know the cause. She had also received several blood transfusions during an abdominal hysterectomy about 20 years before. No adverse effects had been observed after the transfusions. Physical examination was essentially unremarkable except from the orthopedic point of view. Her blood group was O Rh positive and hemoglobin value 13.8 g/100 ml. The serum was screened for antibodies against pooled cells by saline, albumin, and indirect Coombs’ techniques. On September 27, a left total hip reconstruction operation was performed. During the operation she received four units of blood that were crossmatched and found compatible. . .



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