1. Clerical check for paper" errors, for example, blood to the wrong patient.
2. Specimens needed:
a.
Pre-reaction blood of recipient.
b.
Post-reaction blood of recipient (anticoagulated and clot tubes).
c.
Blood from integral donor tubing or container implicated in reaction.
d.
Post-transfusion urine (spun specimen).
3. Investigation procedures (letters refer to specimens listed above):
Immediate
Definitive
Corrobative
Examine for visible +
Repeat crossmatch {a, b,
Identification of any
hemolysis (a, b, c, d).
c, (major and minor)}.
unexpected antibody or
incompatibility.
Bacteriologic smear and
culture (c).
Repeat ABO (a, b, c).
Repeat antibody-
Optional:
Repeat Rh (a, b, c).
haptoglobulin (a, b).
screening (a, b, c).
Direct antiglobulin test (a, b).
methemalbumin (a, b).
bilirubin (b).
creatinine
Direct antiglobulin test (c).
Adapted from Huestis, Bove, and Busch. With permission from Little, Brown, and Co.
* The procedures and specimens listed are applicable to most situations. Of course,
circumstances may vary and require different approaches in particular cases.
* Examine the anticoagulated tube from b as it is less likely than the clot tube to show
spurious "in vitro" hemolysis and can be more rapidly evaluated (spin and observe).
Verify the presence of the implicated rbc antigen on the donor cells (c) and the lack of
this antigen on the recipient's cells (a) for any identified antibody in (b). Absence of a
donor antigen post-transfusion, which the patient lacked pretransfusion, is also
evidence that the donor unit has been eliminated; this may also be reflected In the
failure of the anticipated rise in hemoglobin in the recipient after the transfusion.
Table 3-5. Schedule of investigation of suspected transfusion reactions.
MD0846
3-29
Previous Page
