5 November 2015 (Thursday) - Major Bleed
Oh we had fun at work today. I came in for the late shift and checked off the morning’s blood groups. One was a pre-operative case; blood group O Rh(D) Pos with anti-Fy(a) antibodies.
I thought nothing more of it for an hour or so until the phone rang. This patient was actively bleeding. The surgeons wanted six units immediately. They weren’t impressed when I explained that with this particular antibody “immediately” wasn’t an option. With (about) one unit in three being Fy(a) negative I told them we’d hopefully have something within the hour.
(If you tell them you’ll do it right away when you can’t, they think you are rubbish; when you say an hour and do it much quicker they think you are marvellous)
I had this plan to select six units and crossmatch and Fy(a)-type at the same time. Hopefully I’d get some units to tide them over. Bearing in mind the patient’s phenotype was C+ c- E- e+ K- I thought I’d select units of this phenotype and Fy(a)-type those. It was a good idea; it was a shame we had no such units. In the end I just typed those O Rh(D) Pos units which were labelled as K-Neg.
Bearing in mind the urgency a colleague did likewise, and when I had completed my first six units I did the same on another six units. Between us we tested eighteen units and got eight Fy(a)-Neg units in an hour. In t he meantime other staff phoned to put off other transfusion commitments and to postpone a visit by senior hospital management.
It was as well this happened during a routine working day; I would have struggled were I doing this as a lone worker.
But this made me think. Was I right to have (possibly) wasted time trying to find Rh-matched units? Have I made problems for the future if and when the patient might develop anti-E antibodies? Should we have crossmatched blood immediately on identifying an antibody?
This is one of those cases for which it is very difficult to make a specific plan in advance… I think we did right.