Contributed by Raj Hari, MD
Published on line in April 2002
The patient is a 56 year old female with a 20 year history of systemic lupus erythematosis with a history of deep venous thrombosis and a recent myocardial infarct. The patient was transfused with 2 units of packed red blood cells. During the transfusion of the second unit of blood, the patient developed dark red urine with pain at the IV site with abdominal pain. The patient became hypotensive, going from pre transfusion blood pressure 139/84 to 95/80-post transfusion. A transfusion reaction investigation was initiated. The patient was treated supportively, with intravenous fluids and oxygen. She continued to have hematuria with hemoglobin of 9.6, a hematocrit of 28.4, a lactate dehydrogenase of 844 and blood urea nitrogen of 14 and creatinine of 0.7. Her condition resolved and she was subsequently discharged.
No evidence of clerical error was found. Serological work up showed visible hemolysis in plasma with 3+ hemolysis in the urine. Results of direct coombs (DAT) post-transfusion were positive for IgG antibody. Both pre and post transfusion screens were negative. An eluate performed on the pre and posttransfusion samples were also negative as follows:
An eluate was performed again using polyethylene glycol and the results were as follows:
A post transfusion screen was repeated and the results were as follows: