Woman victim of blood blunder

PUBLISHED : Friday, 19 August, 2011, 12:00am
UPDATED : Friday, 19 August, 2011, 12:00am


A woman is in serious condition in intensive care after receiving the wrong blood type in a transfusion at the Caritas Medical Centre in Sham Shui Po. A doctor and a patients' group said it was a serious mistake that even a new staff member should not commit.

The mistake was discovered when the 64-year-old woman was transferred to the neurosurgery unit at Kwong Wah Hospital after developing a brain haemorrhage.

She was admitted to the Caritas centre on August 9 suffering from scoliosis - a curved spine, with a narrowing of the spinal column, a condition known as spinal stenosis.

She underwent surgery on Monday but her condition remained unstable. She needed a blood transfusion and required a ventilator to breathe, a hospital spokesman said. After the transfer to Kwong Wah, staff there discovered that her blood type was B, not A, as written in Caritas' records.

A preliminary investigation showed that laboratory staff at Caritas swapped her blood test result with that of another patient. The other patient did not require a transfusion and had already been discharged.

The woman is now in Kwong Wah Hospital's intensive care unit in serious condition. The laboratory staff member concerned had been suspended from blood-grouping duties and was given counselling, the spokesman said. The hospital will launch an investigation into the blunder, with a panel comprising doctors and external representatives. It will produce a report in six to eight weeks.

'The hospital has explained the incident and extended an apology to the patient's family,' the spokesman said.

The hospital said it had immediately reminded all departments to comply strictly with guidelines for blood grouping to prevent similar blunders.

The Hospital Authority suspected the mix up was related to incorrect blood-typing procedures.

Chinese University's chief of neurosurgery, Professor Poon Wai-sang, said blood transfusions 'cannot afford to go wrong'. He added: 'Different blood groups have different antigens and antibodies. When they are not compatible, it will affect the clotting of blood.'

He said there could be unstoppable bleeding, or blood clots would block smaller vessels, resulting in multiple organ failure.

The professor said that in the case of a botched transfusion, it was more likely the heart and lungs would be affected as they were the areas that the wrong blood would reach first.

Secretary for Food and Health Dr York Chow Yat-ngok said he had expressed his 'deep regret' at the incident and had asked the Hospital Authority to conduct a thorough investigation.

Patients' Rights Association spokesman Tim Pang Hung-cheong said: 'It is not the first time public hospitals have made such a mistake. The Hospital Authority must review its blood test procedures.'