ABO typing-yes it is important

In a just released report from the Pittsburg Tribune-Review , a VA hospital in Pennsylvania gave a Navy veteran the wrong type of blood plasma due to an error in sample handling. The hospital is saying it was underlying medical conditions that actually killed Kenneth Guthrie, not the inappropriate blood plasma.

What do we know regarding this incident? The patient received 6 units of type O plasma when he actually had type B blood.

Now, normally type O blood is considered the universal donor blood type, but that is for red blood cell transfusion, or only to be used in emergencies when correctly matched rare blood is not available. However, when large volumes of plasma are transfused, there are naturally¬†occurring antibodies called isoagglutinins that are present in the blood/plasma. Isoagglutinins are made to intestinal bacterial epitopes, but for some reason crossreact to ABO antigens found on other blood types. In type O blood, there would be anti-A as well as anti-B isoagglutinins present. When O plasma is transfused, the anti-B antibodies can bind to the antigen on the surface of a patient’s ABO-type B blood cells and started lysing them via complement activation, in a type II hypersensitivity reaction.

Kenneth Guthrie received six units of isoagglutinins. And died within 12 hours of receiving this transfusion. Also, the article stated that:

An internal VA committee later concluded Guthrie suffered “an acute hemolytic reaction due to the transfusion of incompatible FFP,” or fresh frozen plasma, the report states.

That doesn’t sound like underlying medical conditions to me. Also, Mr. Guthrie died in June of ’07. The VA hospital is just now implementing an automatic bar coding system for patient samples to prevent human error. But only¬†after the Pittsburg Tribune story was made public.

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