Case Based Learning and Textbook Chapter Review Session

February 1, 2008
Mollison Chapter 4 ABO, P, Lewis, Ii
AABB Technical Manual Chapters 13 ABO, H, and Lewis Blood Groups and structurally related
antigens
Note: please substitute text of your choice for Mollison
Cases
1. 31 year old male with diagnosis of Non-Hodgkin's Lymphoma was admitted to Hematology in a
teaching hospital. Two months ago he was transfused with 2 units of AB Rh positive blood for
symptomatic anemia as an outpatient in another facility. The transfusion was uneventful. Ten days
prior to his current admission, he was transfused again with 1 unit of AB positive red cells. He
developed a hemolytic transfusion reaction. The patient was subsequently transferred to a teaching
hospital. On admission, the patient's Hb was 68 g/L. Two units of packed red cells were ordered.
Forward Grouping

Reverse Grouping

Anti-A Anti-B Anti-AB Anti-D A cell B cell O cell

4+

4+

4+

4+

2+

Neg Neg

What is the patients blood group? What other investigations would you order?
Comment on further management of this patient.

2. 32 year old A-Rh-pos male with Stevens-Johnson syndrome was admitted to ICU. To manage his
SJS, he was given daily IVIG infusions at 1g/kg for 4 days. Hgb prior to the first infusion was 131 g/L;
it fell to 74 g/L 6 days later. To correct anemia, he was given 1 unit of A pos immediate-spin
crossmatch compatible packed RBC (CM was performed with pre-IVIG serum). After 50 cc were
infused, patients blood pressure dropped to 60/40 mmHg. Transfusion was halted. Hb was 62 g/L and
his LDH and bilirubin were elevated 2x above upper limit of normal.
What further investigations would you order?
Comment on further management of this patient.

3.

56 year old A-Rh-pos female was admitted to hospital with brisk GI bleeding. Admission sample
revealed a negative antibody screen. She was transfused 3 units of RBC on the day of her admission
(Dec 28) and further 2 units 4 days later (Dec 31).
A new blood bank sample was requested on Jan 4. Her antibody screen was positive and DAT
negative. Panel was consistent with an anti-Jka. Between Jan 4 and Jan 18, she received 12 RBC, 2
FFP, 2 pools of 5 RDP and 1 apheresis platelet.
Testing on January 19, revealed a positive antibody screen, AHG crossmatch with Jka negative units
2 out of 3 positive and DAT positive with IgG.
What further investigations would you like to perform?
What do you think is going on?
Comment on further management of this patient.

4. 47 year old male with ITP was transferred from a peripheral hospital to a teaching hospital for further
management. Treatment in the peripheral hospital included IVIG (0.4mg/kg for 4 days) and a pool of 5
RDP. On admission to a teaching hospital he received further IVIG 1g/kg for thrombocytopenic
bleeding. Admission blood bank tests were as follows: antibody screen (MTS) negative, DAT
negative.
Forward Grouping

Reverse Grouping

Anti-A Anti-B Anti-AB Anti-D A cell B cell O cell

4+

N/A

4+

3+

4+

N/A

What further investigations would you like to perform?

What do you think is going on?