Abstract
Background ABO mismatched transfusions are rare. We discuss a case of massive ABO incompatible transfusion with a fatal outcome. Case report 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. Conclusions 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.
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