Question

A 73-year-old male is in surgery for a liver resection. He has 4 units of packed red blood cells that have been tagged as compatible on the shelf. During the surgery, the OR calls the blood bank and request a unit for transfusion. It is checked by the BB staff and sent by the pneumatic tube system to the OR. Ten minutes later, the anesthesiologist calls the blood bank and tells the tech that the patient seems to be having a transfusion reaction. The doctor says that as soon as the blood hits the patient’s vein the patient becomes bradycardic and requires additional respiratory support. When he stops the blood and flushes the line, the patient’s vitals return to normal. The anesthesiologist says that he is going to call a transfusion reaction and send a sample for a STAT workup because the patient needs blood. Results of the workup are below.

Clerical check on the unit label, bag, and paperwork all match.

Pre Transfusion Sample: Blood type = O positive, Antibody Screen = Negative, DAT = Negative

Post Transfusion Sample: Blood type = O positive, Antibody Screen = Negative, DAT = Negative

What type of reaction is consistent with the patient’s symptoms?

Answer 1

The patient undergoing liver resection exhibited bradycardia and needed additional respiratory support during a transfusion, suggesting a transfusion reaction. The negative Antibody Screen and DAT exclude hemolytic transfusion reactions, implying a possible non-hemolytic reaction like hypersensitivity or anaphylaxis.

Step-by-step explanation:

The patient's symptoms of bradycardia and the need for additional respiratory support following a blood transfusion during a liver resection suggest a transfusion reaction. However, the Pre and Post Transfusion Sample results showing a negative Antibody Screen and a negative Direct Antiglobulin Test (DAT) suggest that the reaction is not a hemolytic transfusion reaction, which is typically associated with incompatibility in ABO or Rh blood groups. Given the absence of hemolytic indicators, the symptoms could be consistent with a non-hemolytic transfusion reaction, such as a hypersensitivity or anaphylactic reaction, although these are not conclusively identified by the given workup results. It's important to note that non-hemolytic reactions can still be serious and require prompt recognition and treatment.