Not having a clue about transfusion, I spoke to my local experts for
opinion and they kindly came up with the following.
Hope this is of use
There was an identical reaction at Ipswich Hospital last year which was
caused by an incomplete wash of the salvaged red cells. When blood is
salvaged washing is based on completely full centrifuge bowls so if a
bowl is not completely full the washing is less efficient as the final
product is suspended to a prefixed volume using wash supernatant so the
lower the salvage volume the more wash supernatant is used. The
manufacturers generally recommend an additional wash cycle for
incomplete bowls but in the Ipswich incident as the bowl was almost full
this was not done. Sharon will have the details but we reported to SHOT
but SABRE (MHRA) were not interested.
Cheers, Allan
Ian,
We had a similar experience ourselves and is actually recorded in this
years SHOT report.
The patient was undergoing vascular surgery receiving salvaged blood
back when his BP dropped quite significantly, after some investigation
it was established that first unit of salvaged blood was given 485 mls
with no adverse reaction.
The second unit was slightly under the recommended volume, at 473
mls.after a few ml of this unit had been reinfused, the patient became
hypotensive,and the transfusion was stopped, vasoconstrictors were
given, the reaction was not immediately attributed to the transfusion.
The unit was then restarted, with the same effects. Microbiological
examination revealed growth of coagulase neg staph which was not
considered to be a contributing factor. It was concluded that under
collection may have led to incorrect washing.
Hope this helps
Sharon
Sharon Kaznica
Blood Transfusion Nurse Specialist
Ipswich NHS Trust
Ian Hembling MSc, BSc hons, FIBMS CSci
Advanced Biomedical Scientist (Training and Development)
Clinical Biochemistry
Ipswich
01473 703491 or Ext 5491
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Smith Helen -
Consultant Clinical Biochemist
Sent: 18 July 2008 09:24
To: [log in to unmask]
Subject: strange transfusion effect
Dear All,
Our transfusion friends are looking for some help.
We had a lady delivering by Caesarian section, who was having her own
blood salvaged, filtered and retransfused. She had what was to all
intents & purposes a transfusion reaction. When the transfusion was
stopped BP, heart rate etc returned to normal. When transfusion of her
own blood restarted the same reaction occurred.
The transfusion practitioner has checked the instrument and can find
nothing wrong with it.
So the question is what caused this reaction and is there anything we
can test in her original blood samples or that which was salvaged from
the equipment?
That could help identify the cause?
Could it have been the citrate solution used as anticoagulant?
Thoughts and ideas would be appreciated.
many thanks
Helen Smith
Concultant Clinical Biochemist
Queen Alexandra Hospital, Portsmouth
02392 286000 ext 1280
------ACB discussion List Information-------- This is an open discussion
list for the academic and clinical community working in clinical
biochemistry.
Please note, archived messages are public and can be viewed via the
internet. Views expressed are those of the individual and they are
responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
***************************************************************************
This e-mail and any files transmitted with it are confidential. If you are not the intended recipient, any reading, printing, storage, disclosure, copying or any other action taken in respect of this e-mail is prohibited and may be unlawful. If you are not the intended recipient, please notify the sender immediately by using the reply function and then permanently delete what you have received.
Content of emails received by this Trust will be subject to disclosure under the Freedom of Information Act 2000, subject to the specified exemptions, including the Data Protection Act 1998 and Caldicott Guardian principles.
This footnote also confirms that, unless otherwise stated, this email message has been swept by Sophos Anti-virus for the presence of computer viruses.
***************************************************************************
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|