Department of Immunohematology & Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Transfus Apher Sci. 2022 Aug;61(4):103422. doi: 10.1016/j.transci.2022.103422. Epub 2022 Mar 12.
Blood grouping discrepancy in patients with hematological disorders can occur due to red cell sensitization following transfusion, transplantation, and pregnancy or pre-analytical errors. Prompt initiation of root cause analysis is vital to avoid complications of wrong blood transfusion. We present an unusual case of Rh mismatched grouping report of 24 year old female thalassemia patient being managed in our hospital since 2015. Her current type and screen were observed as O Rh D negative with negative antibody screen while the historical blood group was O Rh D positive. The pre-analytical errors were ruled out and blood grouping performed from fresh sample also demonstrated as O Rh D negative despite antigen enhancement techniques and had no recent transfusion history. We sought to reason out the possibilities for discordant Rh grouping report, historical and present group through "Funnel based problem solving 5 WHY analysis" approach. The review of the past clinical history revealed that the patient had undergone Rh mismatch bone marrow transplant (Rh D positive donor and Rh D negative recipient) at 5 years of age which soon resulted in graft failure. Yet, she continued to receive Rh D positive blood thereafter with no development of anti-D which explains the historical blood group. Recently the patient was started on thalidomide, the Hb F inducer drug, which helped in maintaining her hemoglobin level between 9 and 10 g/dl without transfusion support for two months. This allowed unmasking of native Rh D negative blood and the review of clinical history played a significant role in resolution of grouping discrepancy.
在患有血液系统疾病的患者中，由于输血、移植和妊娠或分析前的错误导致红细胞致敏，可能会出现血型不合。及时启动根本原因分析对于避免错误输血的并发症至关重要。我们报告了一个不寻常的 Rh 血型不合的病例，患者为一名 24 岁女性地中海贫血患者，自 2015 年以来一直在我院接受治疗。她目前的血型和筛查结果为 O 型 Rh D 阴性，抗体筛查阴性，而既往的血型为 O 型 Rh D 阳性。排除了分析前的错误，对新鲜样本进行的血型鉴定也显示为 O 型 Rh D 阴性，尽管使用了抗原增强技术，且患者最近没有输血史。我们试图通过“基于漏斗的问题解决 5 个为什么分析”方法来找出不一致的 Rh 血型报告、既往和现在的血型之间的可能性。回顾过去的临床病史显示，患者在 5 岁时接受了 Rh 不合的骨髓移植（Rh D 阳性供体和 Rh D 阴性受者），随后很快发生移植物失败。然而，此后她继续接受 Rh D 阳性血液输注，并未产生抗-D，这解释了既往的血型。最近，患者开始服用沙利度胺，这是一种 HbF 诱导药物，使她的血红蛋白水平在 9 到 10g/dl 之间维持了两个月，无需输血支持。这揭示了患者的固有 Rh D 阴性血型，临床病史的回顾在解决血型鉴定差异方面发挥了重要作用。
