An Intravascular Hemolytic Transfusion Reaction due to Anti-'Mi^a' in Taiwan

Abstract

Background: Anti-Miª is the most frequently occurring alloantibody of potential clinical significance in Taiwanese patients and its frequency was 1.2% among the patients.1 Case report: This 44-year-old, 45.1 kg man had the past history of soft palate carcinoma and being with GI bleeding. After being admitted into our hospital, he received 1 unit of PRBC blood transfusion at 15:20 on 28, Dec., 2013, but complaint of chills and dizziness at 16:35 and was noted with developing fever and hypotension. After blood transfusion of approximate 80 ml PRBC, the patient's temperature rose to 39.1°C from 37°C, so blood transfusion was discontinued. The blood pressure dropped to 88/52 mmHg from 118/65 mmHg afterwards. According to the investigation, a clerical error was noted. The crossmatch was repeated and the patient was with anti-Miª. An incompatible result demonstrates Miª + unit (Manual Polybrene: 2+s). However, the blood sample which was obtained 5 h after transfusion indicated no gross hemolysis. After being applied antipyretic, antihistamine and steroid, the patient became afebrile and had normal urine amount. His blood pressure recovered gradually. The post-transfusion data are as follows. The serum revealed direct bilirubin 1.6 mg/dl, total bilirubin 2.8 mg/dl, haptoglobin 26.5 mg/dl (36.0-195.0), fibrinogen 429 mg/dl (200-400), BUN 35 mg/dl (8-20), and creatinine 1.6 mg/dl (0.4-1.2) The urinalysis showed 1+ protein, 1+ bilirubin, and 3+ blood hemoglobinuria. The lab data are consistent with acute hemolytic transfusion reaction. The patient's data are shown in following table1. The following incident could be prevented by building blocks of a quality management. The medical technician performed compatibility testing for two patients at the same time and then issued Miª Ag(+) blood to the patient with anti-Miª. She did not follow SOP to use the applicable computer system to match recipients identifying information on release request with corresponding information on the dedicated blood components. Thus, the adverse event was caused in the process of issuing blood products and the reporting system could not prevent from the medical error by an alarm mechanism. Quality management systems (QMS) should be established in blood bank to prevent from recurrence and a blood bank can combine three levels as technical parameters based on ISO 9000, the Standards of Practice and ISO 15189 (Bust, 2011) to strengthen patient safety. In this case, wrong component release is a severe quality indication.(Anyaegbu, 2011) Some element key elements should be taken care. Review: Case1: There was another occasional case, transfusion reaction (TR) happened after the patient received 50 ml RBC and his temperature rose to 39°C. The other clinical symptoms were hot flushes and anuria.2 Case2: Another case was referred to our hospital due to TR. After 10 ml washed RBC were transfused, the patient experienced severe dyspnea and chills.{Broadberry, 1994}.