Miscued Chemotherapy Causes Internal Bleeding, Girl Dies

by Gopalan on Sep 20 2009 11:08 AM

A 20-year-old British girl, suffering from a rare blood disorder, died of internal bleeding following an accidental puncturing of her jugular vein. And there was a two-hour delay in blood transfusion.

Sally Thompson, an administration assistant for Rochdale Council, had suffered from a rare blood disorder, hemophagocytic lymphohistiocytosis (HLH), since she was eight. The condition caused her immune system to fail and doctors said she would eventually need a bone marrow transplant.

On August 22, 2005, she collapsed at home in Middleton, Manchester, and was admitted to the Royal Infirmary, an inquest was told.

Doctors stabilised her, but two days later she had a series of fits and was transferred to intensive care. The following evening, and with the fits still going on, doctors decided to start her on a course of chemotherapy.

They decided to insert a tube called a central venous catheter into her jugular vein to administer the chemotherapy drugs directly into her bloodstream.

A technique known as 'landmark' was used to find the blood vessel.

But when the tube was inserted, it caused internal bleeding.

The landmark technique, which involves mapping out the features of the neck to find the vein, was contrary to guidelines, which recommend using an ultrasound scan to find the vein.

Apparently the doctor who was attending on her had used the technique many times earlier and he also consulted colleagues before going ahead.

Her father John Thomson said: 'It punctured Sally's vein and, unbeknown to them, she was bleeding into her chest cavity for almost an hour.

'When they did find out they sent an order down for blood but the bank said they were having trouble finding any cross-matched blood because of her disorder.'

Cross-matching blood, in transfusion medicine, refers to the complex testing that is performed prior to a blood transfusion, to determine if the donor's blood is compatible with the blood of an intended recipient, or to identify matches for organ transplants. Cross-matching is usually performed only after other, less complex tests have not excluded compatibility. Blood compatibility has many aspects, and is determined not only by the blood types (O,A,B,AB), but also by blood factors, (Rh, Kell, etc,). Cross-matching is done by a certified laboratory technologist, in a laboratory.

But in an emergency when there is no time for cross-matching, blood of the same type as the patient's -  in Miss Thompson's case O-negative, one of the most common types  -  can be given.

The inquest was told that doctors did eventually request non-cross-matched blood, but by then it was too late.

Miss Thompson died before any blood arrived after having a heart attack caused by the internal bleeding.

Speaking after her inquest, her father John, 62, said she would still be alive if the blood had been available sooner.

The retired farmer said: 'This hospital is supposed to be the cornerstone of the NHS in Manchester, but they couldn't get any blood for two hours.

'We have never had any answers about why it took so long. I feel very let down by the hospital.'

Coroner Nigel Meadows said the inability to supply the blood was a 'significant failure' and he would write to hospital bosses.

He also said he would ask hospital bosses to review the procedure relating to central venous catheters.

'No crossmatched or uncrossmatched O-negative blood was supplied, despite it being requested during the resuscitation, and this was a significant failure,' Mr Meadows said.

'Blood salvage was organised but not initiated until towards the very end of attempts to resuscitate the deceased.'

A hospital spokesman said it had reviewed procedures concerning CVCs and was investigating why no blood was ever supplied for a transfusion, Liz Hull reported for Daily Mail.