For each blood transfusion problem A–E, select the most appropriate option from the following list
1. ABO incompatibility.
2. Rhesus incompatibility.
3. Major incompatibility.
4. Minor incompatibility.
5. Multiple repeated transfusions.
6. Massive blood transfusion.
7. Use of stored blood.
8. Use of fresh blood.
- A patient has been given three units of blood during a surgical operation. Just after the operation the patient is at risk of inadequate tissue oxygenation despite satisfactory arterial blood pressure, haemoglobin and arterial blood oxygen saturation leve
- A patient has been given two units of blood on the day before a planned surgical operation. Towards the end of the transfusion the patient was noted to have mild fever, and the next morning slight jaundice was noted in the conjunctivae
- A patient admitted with vomiting of blood shows signs of circulatory failure and is given a unit of blood quite rapidly. As the transfusion is nearly completed it is discovered that there has been confusion between two patients with exactly the same first
- During emergency surgery for a dissected aortic aneurysm, a condition notorious for severe bleeding during operation, a patient is transfused with 20 units of blood. Despite restoration of a normal blood volume this patient is at risk of hypothermia, tiss
- A patient with failure of bone marrow function causing aplastic anaemia is admitted for transfusion as the haemoglobin level has fallen to an unacceptable level. The blood bank report difficulty in finding suitable red cells due to problems with some of t
Medicine
A. Option 7 Use of stored blood. This blood has the characteristic property of stored blood – a low level of 2:3-DPG. Hence the blood oxygen dissociation curve is shifted to the left, and the blood does not give up adequate oxygen at tissue oxygen tensions.
B. Option 4 Minor incompatibility. There has been a mild antibody rejection of the donor red cells. A relatively small number of these have been broken down (lysed) to release bilirubin which causes the jaundice. The immune response also releases products, including interleukin-1, which cause the fever.
C. Option 3 Major incompatibility. This type of mistake carries a high risk of death because the recipient’s naturally occurring anti-A antibody (agglutinin) rapidly destroys the transfused group A red cells, releasing huge amounts of deadly toxins.
D. Option 6 Massive blood transfusion. A massive blood transfusion is defined as one where the volume of blood transfused equals or exceeds the patient’s original blood volume. Stored blood carries the problem mentioned in (A) but because large volumes of blood must be given very rapidly there is not time to heat them to body temperature from their initial low temperature, so the patient’s core temperature drops (hypothermia). This compounds the shift in the blood oxygen dissociation curve and also slows the coagulation reactions.
E. Option 5 Multiple repeated transfusions. Such patients require regular blood transfusions on repeated occasions, so their immune system builds up antibodies to minor blood group antigens such as M, N, Kell and Duffy
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