Case 19 – update 1

For the start of the case see below… or click https://teamhaem.wordpress.com/2014/01/26/case-19-the-beginning/

There are a few points which #teamhaem have correctly identified:

1) The patient is usually neutropenic or is at risk of neutropenia; therefore it is important to treat this person on the Trust neutropenic sepsis protocol.  Patients can deteriorate rapidly if not assessed and treated appropriately and swiftly.

2) A thorough assessment is imperative.  This may point towards potential causes of sepsis.

3) Blood transfusions are not without risk.  One of the long term risks is iron overload.

The patient was last in the department the week previous for her regular transfusion when she was well. Over the past few days she has had shivers and felt tired. She has felt more short of breath and has had a cough.  No urinary symptoms.  She’s had an episode of loose stool.  Examination revealed tachypnoea and tachycardia, but chest and abdominal examinations were normal.  Bloods revealed:

  • Hb 79g/L
  • Neuts 1.02×10*9/L
  • PLT 89×10*9/L

Questions:

  • What is your next stage in the management of this patient?
  • What investigations do you do?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion

About TeamHaem

Online education and discussion about all things haematological
This entry was posted in Anaemia, Bone marrow failure, Transfusion and tagged , , . Bookmark the permalink.

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