Findings from NHO Annual Report 2011 Serious Adverse Reactions

DHTR – Case 1An elderly patient was admitted with a GIbleed and symptomatic anaemia Hb7.0g.dl.A sample was referred to the referencelaboratory anti c, anti Jka and anti Swere identifiedPretransfusion antibody screen wasnegative Transfused with 8 units of redcells over a four day period.Hb failed to rise.Unclear whether this was due to ongoingbleed or haemolysis.On investigation the patient had anelevated bilirubin levelRepeat group and antibody screen waspositive for anti c and an unidentifiedantibody.On further investigation in the HBB aprevious antibody card labelled with thepatients name was identified indicationthe patient had a previous anti c and antiJka, however as the patient identifierswere incomplete it could not beconfirmed as the same patient.On further discussion with the patient sheidentified that during her pregnancies shehad been advised of her antibodiesDAT was also positive26/11/2012 National Haemovigilance Office 15