Antibody Identification in a Patient with Chronic Lymphocytic Leukemia: A Case Study

CASE PRESENTATION A 77-year old man from Tennessee was on vacation in southwest Florida. He presented to the emergency room (ER) complaining of a sudden onset of weakness, fatigue, chest pain, and shortness of breath. Pertinent clinical history included diagnosis and chemotherapeutic treatment of chronic lymphocytic leukemia (CLL) ten years ago resulting in remission. This past year, the patient had a recurring episode of CLL and subsequent to treatment went back into remission. The patient had a routine physical with laboratory testing including a complete blood count (CBC) and a chemistry panel one month previous to this ER episode with all results reported within the reference range. The ER attending physician ordered hematology, coagulation, and chemistry laboratory tests. The results were reported to the physician with attention to the ‘critical values’ (Table 1).

Subsequent to the receipt of the initial laboratory results the ER attending physician ordered four units of packed red blood cells (RBCs) and admitted the patient to the hospital's intensive care unit. The results of the type and crossmatch are seen in Table 2.

The patient had no previous transfusion history. The immediacy of need was recognized with the resulting low RBC count and hemoglobin. Hospital transfusion services processed several units with no compatible units identified. A request from the hospital transfusion services to the regional blood bank for assistance was initiated. Leukocyte-reduced RBCs were obtained from the regional blood bank supply and administered to the patient.