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.
