Death by blood: a fatal case of massive ABO-mismatched transfusion

• Published in: Pathology Vol. 43; p. S26
• Main Authors: Beligaswatte, Ashanka, Davis, Ken
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 2011
• ISSN: 0031-3025; 1465-3931
• DOI: 10.1016/S0031-3025(16)33138-5

ABO mismatched transfusions are rare. We discuss a case of massive ABO incompatible transfusion with a fatal outcome. A 75-year-old female received 6 units of packed red cells during an aortic arch repair surgery at another health care facility. Post-operatively, she developed shock, worsening coagu-lopathy, and multi-organ failure, despite receiving a further 41 units of packed red cells, 20 units of fresh frozen plasma, and 5 bags of platelet concentrates, over a period of 7 days. This was attributed to ongoing bleeding and the consequences of a massive transfusion. Compatible blood was urgently requested from our transfusion service. However, crossmatching was unsuccessful due to all panel cells being reactive, and the presence of a ‘front-back’ discrepancy. The patient died shortly after the request was made. An approach to the ‘front-back’ discrepancy is discussed. ABO incompatible transfusions may not be recognised as a cause of refractory shock and multi-organ failure.