Question

Jane S. was admitted for a redo of a hip arthroplasty and had an order for 2 U of packed RBCs. She received 2 U of packed RBCs 1 year prior when she had the original hip surgery. Jane typed as A positive, and a review of her transfusion history found no prior history of alloantibodies. She was transfused with 1 U of packed RBCs during surgery.
Review Figure 1-7, antibody screen 1, done on 11/21/00.
QUESTIONS
1. Does the antibody screen indicate the presence of any alloantibodies?
2. On 11/28/00, a type and crossmatch were ordered because the patient's hemoglobin and hematocrit were dropping.
Preop hemoglobin and hematocrit 11.9 g/dL (reference range 12 to 16 g/dL); 35.6% (reference range, 37 to 47%)
11/28/00 hemoglobin and hematocrit 8.0 g/dL; 24.1%
What is the most likely explanation for the drop in hemoglobin and hematocrit?

Figure 1-7. ANTIBODY SCREENS Antibody Screen 11/21/00 P LutheranT No. Rh Rhesus Kell Linked Antibody Screen 2 11/28/00 Duffy Kidd Sex Lewis MNS Linked No. Rh Rhesus Kell Le 37 | AHGİCC 0 2. NT: not tested AC: autocontrol

Answer 1

Answer-

1- No,she is not having any alloantibodies ,the screen is not having proper explaination, however the phenomenon happening here is I'm explaining in answer no. 2

2- The fall in haemoglobin and haematocrit is not due to alloantibodies but this is due to this surgical procedure, It's hip arthroplasty ,most probably it had involved bone marrow which is responsible for synthesis of RBC, in post OP period other sites does not get that much adapted to form number of RBC required,hence immediately in post op period the haemoglobin and haematocrit has fallen.