BLOOD TRANSFUSION IN

AUTOIMMUNE HEMOLYTIC ANEMIA

A challenge to Transfusion Medicine
Dr.Shaiji.P.S
Junior Resident
Department of Transfusion Medicine
Medical college,Trivandrum
 Introduction
• AIHA- Problems in blood banking

– Incompatibility with majority of donor cells

– Time constraints
– Availability of reagents and experts

• Resort to the most feasible and practical approach

• Effective communication with the treating physician
 Case I
• 49 yr old female
• Warm AIHA
• Multitransfused &multiparous
• Request for 2 unit PRC
• Hb 4 g%,no cardiac failure
• Blood bank
– Blood Group O negative (forward and reverse)
– Saline autocontrol negative
– autoagglutination in different temperatures tested

Temperature Result
4o C nil
37o C 4+

22o C nil

•Cross matched with 6 U of O negative PRC

 Result
SAMPLE IS LISS-COOMBS
GEL

DONOR1 COMPATIBLE 2+

DONOR 2 COMPATIBLE 3+

DONOR 3 COMPATIBLE 2+

DONOR 4 COMPATIBLE 3+

DONOR5 COMPATIBLE 2+

DONOR6 COMPATIBLE 2+
• Clinician was contacted
• Discussed the emergency
• Decided to postpone transfusion as far as safe
• Started on high dose steroids
• Immunosuppressant added
• Iron and folic acid
• General condition improved
• Hb raised to 6 g%
• Transfusion avoided
1 year later…..
Patient posted for splenectomy
Gap of communication
Request to keep CMR reached blood bank only just
before surgery
No time for complete tests
Surgery postponed
• Consulted clinical haematologist
• Methyl prednisolone 3 days
• DCT 1+
• 3 units crossmatch compatible,
• Splenectomy done successfully
• Rapid improvement
• No more blood transfusions required
 Case II
• 7 yr girl
• AIHA newly diagnosed
• Hb 3g%
• DCT 4+
• Symptomatic
• Cross match with 8 donors
• Compatible in saline
• All Incompatible in liss coombs gel card (37
AHG )
• Auto absorption done 3 times
• No antibody screening panels
• 4 units cross matched with absorbed serum
• Compatible
• Issued 100ml aliquots
• Transfused without complications
 Case III

• 48 yr man DM,CLD,CKD
• Blood sample sent for grouping and crossmatching
• Result

ANTIA ANTIB ANTIAB Anti Rh A CELL B CELL O AUTOCT

CELL RL

2+ 2+ 3+ 4+ 3+ 3+ 3+ 2+
• Washed with warm (37o saline
• Warmed centrifuge cup
• Difficult to maintain temperature
ANTIA ANTIB ANTIAB Anti Rh A CELL B CELL O AUTOCT
CELL RL37

- - - 4+ 3+ 3+ - -

• O positive
• Immediate spin at RT phase omitted,37o compatible units selected
• Warmed to 37 0 in a warmer and issued
• Instruction to physician
 Case IV
• 11 yr old girl
• Primary AIHA
• B positive
• DCT 3+
• Incompatiblility with all the units crossmatched
• Titration crossmatch done and least incompatible transfused
in 100 ml aliquots whenever emergency
• Patient had fever and chills during 3 consecutive transfusions
• Blood transfusion had to be stopped and unit wasted
• Post transfusion investigations-no evidence of Hemolytic
transfusion reactions
• Difficult to ascertain-patient already has some hemolysis
• Time consuming and cumbersome
• Assumed FNHTR
• Discussed with paediatrician
• Patient was transfused with only Washed packed cells from
next time
• No more episodes of FNHTR
 Case V
• 24 yr male
• Road Traffic Accident
• Patient in Shock
• Request for 2 unit Whole blood-emergency
• Blood grouping-

ANTI ANTI ANTI Anti A B O AUTO

A B AB Rh CELL CELL CELL CTRL
2+ 2+ 3+ 4+ 3+ 3+ 3+ 2+
• Contacted casuality resident
• Blood sample was taken from same infusion line asHydroxyethyl starch
• Repeat sample requested from different line
• Red cells washed thoroughly before grouping

ANTIA ANTIB ANTIAB Anti Rh A CELL B CELL O AUTOC

CELL TRL

- - 3+ 3+ 3+ - -

O positive
 Case VI
 SLE+AIHA-2yrs
 DCT +
 Multitransfused
 Hb 3g%
 Patient in cardiac failure
 Autoabsorption –still reactive with donor cells at the end of 3 cycles
 24 units cross matched
 One compatible
 Antibody screen would have helped a lot
Thank you!