Management of a complicated case of liver transplant patient with multiple alloantibodies

Abstract

The focus of transfusion services is now shifting toward the prevention of alloimmunization and delayed hemolysis, especially in multi-transfused patients. Here, we present a complex case of a multitransfused chronic liver disease patient, alloimmunized with multiple Rh antibodies posted for a liver transplant. Our blood bank successfully managed this patient and was able to supply the required blood components on time to save his life. A 28-year-old male patient was admitted to our hospital for the liver transplant. Blood bank could not find compatible blood units for the patient. The patient antibody screen was positive and the pattern was suggestive of anti-E antibody, but few other antibodies such as C, K, Fyb, and N could not be ruled out. Eluate showed the same result on antibody screening. The patient serum was alloadsorbed with “rr” blood using conventional tube technique. Adsorbed patient serum showed the pattern of hidden anti-C and we confirmed that patient serum contained anti-E and anti-C antibodies. As “e” antigen is a high prevalence antigen, we could not find an e negative unit and only C negative unit could be provided to the patient without any untoward incidence.

Keywords

• Adsorption
• alloimmunization
• antibody identification
• anti-C
• anti-e
• elution
• multiple alloantibodies