The Blood Transfusion laboratory at University Health Network, part of the Laboratory Medicine Program (LMP), is one of the busiest blood transfusion labs in the country. Recently, the blood transfusion team had lighting strike twice when two different patients with the same immunoglobulin “A” (IgA) deficiency presented for surgery with minimal notice to the blood transfusion laboratory. Both patients needed blood to be prepared for their surgeries in case they needed a blood transfusion during the operation. Patients who have this deficiency and need a blood transfusion must get blood that was donated by a donor with the same deficiency. These donors are rare as only 1 in 700 people are IgA deficient.
When the UHN blood transfusion team found out that the Canadian Blood Services (CBS) had no IgA deficient donor red cells on hand in Toronto, they worked through the weekend with the CBS to get the only acceptable alternative: “washed” blood. Washing the blood means that the lab removes most of the IgA protein present in regular donors, making it IgA deficient. If “regular” blood is transfused to these patients, they can have a severe allergic reaction (anaphylactic shock) that could lead to death.
These washed donor red blood cell units can be transfused to an IgA deficient patient usually with no transfusion reaction. Along with the transfusion medicine specialist on call, Dr. Yulia Lin, the UHN blood transfusion team, the CBS and the surgical team all worked together to plan when the surgery could proceed based on having the washed blood prepared and delivered to hospital.
The CBS also found 2 units of IgA deficient frozen plasma, a blood product used to aid coagulation, in another province and had it flown in immediately into Toronto in case it was needed. Our hospital sees about one or two IgA patients per year that require blood products.
However, having two patients with the same deficiency within a week of each other required significant planning and preparation from the blood transfusion team to avoid a severe transfusion reaction. The Medical Laboratory Technologists in the laboratory were quick to act when the deficiency of IgA was known to them to ensure the patient did not get transfused with regular blood and to arrange for IgA deficient or washed blood.
“Having a patient with this rare deficiency means the team was always communicating and collaborating with the healthcare team,” explained Sally Balmer, Manager, Blood Transfusion. “The lab staff were in constant contact with Canadian Blood Services, the surgeons and our blood transfusion specialists to make sure we were prepared.”
The surgery on the first patient went well and there were no complications. The surgeon thanked the blood transfusion team for their organization and planning for this rare occurrence.
But, lightning then struck twice and a second patient was identified at the Toronto Western Hospital who was to undergo surgery and also had an IgA deficiency. There were already some IgA deficient products ready and available from the other patient.
These were sent to Toronto Western immediately and additional units were prepared at the Toronto General blood transfusion lab. The team also relied on the support of Dr. Jeannie Callum, the Transfusion Medicine Director on-call, who helped preserve the patient’s own blood and worked with the surgical team to use certain drugs that would help the clotting and reduce bleeding, requiring less blood to be transfused.
With Dr. Callum’s support, the team only needed to transfuse two units of the IgA deficient blood during surgery and could retain the extra units, along with some additional blood product from CBS, in case any post-operative transfusions were required.
“Having our blood transfusion teams work together for these patients is a another example of superlative laboratory collaboration,” said Dr. Marciano Reis, Chief, Department of Laboratory Hematology, which includes Transfusion Medicine. “Both Dr. Lin and Dr. Callum are located at Sunnybrook Health Sciences Centre, but they are part of a team of five very busy transfusion medicine specialist physicians responsible for clinical coverage, protocols, education and research activities in Transfusion Medicine across our partnership. The whole team works together for patients at UHN, Sunnybrook, Lakeridge Health and several other blood banks throughout the province.”
“The lab team was proactive and involved with every step.” said Sally. “We wouldn’t be able to operate a blood transfusion lab as extensive and complex as we do at UHN without such an involved and responsive team. We’re very proud of how hard they work and how dedicated they are to our patients. They’re a great team.”