TRANSFUSION INCOMPATIBILITY CASES
Case Study #2
A 32-year-old white woman has Hodgkin's lymphoma and requires multiple transfusions. Since
her admission two weeks ago, she has received six units of red blood cells (RBCs), several pools
of Group O platelet concentrates and, most recently, apheresis platelets. The oncologist orders
two units of RBCs for immediate transfusion. The results of the pre-transfusion compatibility
testing are as follows:
Anti-A
4+
Anti-B
0
Anti-D
3+
Rh Con
0
A1 Cells
0
B Cells
3+
Screen cell I
Screen cell II
Screen cell III
Auto control
IS
NA
NA
NA
NA
37°C/LISS
0
0
0
0
AHG
0
0
0
1+
CC
2+
2+
2+
NA
Unit #1, A pos
Unit #2, A pos
0
0
0
0
0
0
2+
2+
Because of the positive auto control, a DAT was performed on RBCs from an EDTA sample:
Polyspecific
Anti-IgG
Anti-C3
1+
1+
0
An elution of the patient's RBCs was performed. The results are shown below:
A cells
B cells
Screen cell I
Screen cell II
Screen cell III
AHG
1+
0
0
0
0
CC
2+
2+
2+
2+
Last Wash
0
0
0
0
0
CC
2+
2+
2+
2+
2+
1. Discuss the indications and contraindications for platelet transfusion.
CLS 412 Clinical Laboratory Science Theory, Application and Correlation
Transfusion Incompatibility Case #2
Page 1
2. What do the eluate results reveal?
3. Why didn’t the screen cells react with this antibody?
4. Is there anything in the patient's transfusion history that explains these results?
5. Why were the crossmatches compatible?
6. What ABO group of RBCs should now be administered?
7. What can be done to minimize this problem?
8. For a diagnosis of Hodgkin’s lymphoma to be made, what diagnostic cell must be seen on
lymph node biopsy?
9. How is the aggressiveness of the malignancy determined? What is the prognosis?
CLS 412 Clinical Laboratory Science Theory, Application and Correlation
Transfusion Incompatibility Case #2
Page 2