Abstract
Blood grouping discrepancy in patients with hematological disorders can occur due
to red cell sensitization following transfusion, transplantation, and pregnancy or
pre-analytical errors. Prompt initiation of root cause analysis is vital to avoid
complications of wrong blood transfusion. We present an unusual case of Rh mismatched
grouping report of 24 year old female thalassemia patient being managed in our hospital
since 2015. Her current type and screen were observed as O Rh D negative with negative
antibody screen while the historical blood group was O Rh D positive. The pre-analytical
errors were ruled out and blood grouping performed from fresh sample also demonstrated
as O Rh D negative despite antigen enhancement techniques and had no recent transfusion
history. We sought to reason out the possibilities for discordant Rh grouping report,
historical and present group through “Funnel based problem solving 5 WHY analysis”
approach. The review of the past clinical history revealed that the patient had undergone
Rh mismatch bone marrow transplant (Rh D positive donor and Rh D negative recipient)
at 5 years of age which soon resulted in graft failure. Yet, she continued to receive
Rh D positive blood thereafter with no development of anti-D which explains the historical
blood group. Recently the patient was started on thalidomide, the Hb F inducer drug,
which helped in maintaining her hemoglobin level between 9 and 10 g/dl without transfusion
support for two months. This allowed unmasking of native Rh D negative blood and the
review of clinical history played a significant role in resolution of grouping discrepancy.
Keywords
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References
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Article info
Publication history
Published online: March 11, 2022
Accepted:
March 9,
2022
Received in revised form:
February 9,
2022
Received:
December 6,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
