2023 Volume 72 Issue 2 Pages 281-286
We encountered two hematological disease patients with heart disease complication, who were urgently admitted to our hospital, when they needed to prepare for transfusion with difficult-to-judge pretransfusion test results. The first patient was a 79-year-old Caucasian male who visited a physician for severe chest pain, dyspnea, and edema while traveling. He was diagnosed as having acute congestive heart failure and transported to our hospital by ambulance. The referral letter stated that he had frequently received transfusions of red blood cells (RBCs) and platelet concentrates (PCs) for myelofibrosis. On ABO blood typing upon arrival, judgment on the type of cells to transfuse was delayed because of inconsistency between cell group typing and reversed typing. AB-type PCs and O-type RBCs were transfused, partly on the basis of the presumed use of type O blood in previous transfusions in England. The second patient was a 52-year-old male who developed tachycardiac atrial flutter during hemodialysis for Bence–Jones multiple myeloma (BJ-MM)-induced kidney failure and was transferred to our hospital for ablation treatment. Treatment for BJ-MM was not mentioned in the referral letter. All irregular antibody screening cells and panel cells except for autologous blood cells were positive, and antibody identification was impossible. Upon request, the referring hospital indicated that daratumumab had been administered for three months. All DTT-treated screening cells were negative. No blood transfusion was performed. These cases show the importance of a referral letter providing a description of treatment, which may affect pretransfusion testing for safe and prompt emergency blood transfusion.
