Advocate Christ Medical Center Oak Lawn, Illinois, United States
Background/Case Studies: A 47-year-old male patient (B Positive) with Filipino ancestry was transferred to our medical center from a neighboring community hospital for resection of a distal esophageal malignancy. Five units of red blood cells (RBCs) were requested for surgery. Previous reference laboratory reports were obtained from the transferring hospital showing Anti-Jk3. For the current sample Anti-Jk3 was identified in the serum and in an eluate. The Jk3 antigen prevalence in most populations is 100% and in Polynesians, and Finns the prevalence is >99%. The Jk3 (Jk(a-b-)) null phenotype is relatively more common in the Polynesian population. Anti-Jk3 may cause severe immediate or delayed transfusion reactions. The question was how can the site obtain multiple Jk3 negative blood products so that the surgical procedure could be performed?
Study
Design/Methods: When surgery was originally scheduled the patient’s hemoglobin (Hgb) was 5.9 g/dL, so a national rare donor search was initiated by the blood supplier. A frozen deglycerolized Red Blood Cell (RBC) was transfused and the Hgb increased to 6.3. The patient was discharged, and surgery was scheduled for 3 months out. Family and friends wanted to help recruit donors and there were 53 potential donors recruited, eight were blood relatives. One Jk(a-b-) donor was found, the patient’s sister, but unfortunately this individual was unable to donate because of a surgical deferral. The patient was started on Erythropoietin therapy to increase the RBC and hemoglobin level as much as possible prior to surgery.
Results/Findings: Patient returned for surgery, and it was determined that use of cell saver was not an option due to the malignancy diagnosis. Rare donors were recruited and three Jk(a-b-) RBCs (2 frozen, 1 liquid) were available for surgery. One deglycerolized RBC and 1 liquid RBC were delivered to the hospital site the day before surgery. The Erythropoietin therapy made a huge difference and the pre-operative Hgb was 14.3 g/dL. The deglycerolized unit was transfused post operatively, and patient was discharged with a Hgb of 13.1. The unused liquid unit was held until the patient was discharged and then returned to the blood supplier to be frozen for future use. Conclusions: Although a large number of people wanted to be tested for possible compatibility, only family members had a high potential to be a match and one potential Jk(a-b-) donor was identified with a temporary deferral. The use of Erythropoietin therapy and iron supplementation made a huge difference in the number of RBCs that were needed during the surgery and post operatively. Close coordination with blood supplier reference lab, Transfusion Medical Director and attending physicians was essential to the great outcome of the patient.
Importance of research: Patient presented for surgery and found to have a rare antibody. Surgery was delayed as antigen negative units for the patient was searched for. Patient was given Epo and iron while awaiting units to be located. 3 units were located. The patient 's hemoglobin was substantially increased from the Epo and iron. 2 units were on hand the day of surgery. Surgery was performed and the patient only required transfusion of 1 of the rare units. The other unit was returned to the blood supplier.
