R2R2 phenotype blood requirements for liver transplantation surgery in a child with multiple Rh antibodies: Meeting needs and changing Indian scenario

Abstract

Red cell alloimmunization often poses challenge for transfusion support during surgery. As transfusion needs are unpredictable in liver transplant recipients, it requires well-equipped immunohematology laboratory for timely antibody identification and good coordination with other blood centers, for the arrangement of compatible units in case of rare phenotypes. We present a case of child with multiple Rh antibodies (Anti-C & anti-e) requiring rare R2R2 phenotype blood units for liver transplantation. With no antigen negative units available in inventory, various blood centers in India were approached individually and through social media. Eleven R2R2 units were transferred by air from three blood centers from North India (New Delhi) to South India (Chennai) with the help of Courier services maintaining cold chain over 24 h with data logger facilities. The patient underwent LT with 2 units (R2R2 phenotype) transfused intraoperatively and 3 units in postoperative period. The patient was discharged on postoperative day 18 with Hb 8.0 gm/dL. The case highlights the need for national/zonal database of rare phenotype blood donors to timely fulfil the blood requirement of patients in need.

Keywords

• alloimmunization
• anti-e
• liver transplant
• patient blood management
• r2r2 phenotype
• rare donor registry
• rh antibodies