Case 34 – update 2

We have a patient with sickle cell anaemia post op who is now more anaemic. She also has a sickle cell crisis with abdominal pain. She has a rather elevated CRP which may be post op or due to the sickle cell, but we decide to start emperic antibiotics.

Potential causes of anaemia:

  • Surgical blood losses – remember she is post op
  • Other blood losses – GI bleeding etc.
  • Haematinic deficiency (unlikely to come on so acutely)
  • Haemolytic transfusion reaction
  • Hyperhaemolysis syndrome
  • Parvovirus

Arterial blood gas (on air) reveals PaO2 10.1, PaCO2 4.3, HCO3 21, pH 7.36

Blood film shows sickle cells and very occasional spherocytes.

USS abdomen shows no collections, but surgeons keen for CT scan, although don’t think the pattern fits with surgical blood loss.

Questions:

  • How do you investigate a transfusion reaction?
  • What complications are sickle patients at risk post op?

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