Our patient is treated for potential pulmonary oedema associated with blood transfusion (transfusion-associated circulatory overload). The differential was TRALI but given its rarity and the patient’s observations (hypertension and a positive fluid balance) TACO was felt to be more likely. His post transfusion Hb was 105g/l having had two units (he weighs 48kg). After 40mg of IV furosemide he has a good diuresis and within 24 hours his oxygen saturations have normalised.
A week later he is reviewed prior to colonoscopy. He is feeling more fatigued and his daughter thinks he looks yellow. Blood tests reveal:
- Hb 75g/l
- WCC 10.8×109/l
- Neutrophils 6.9×109/l
- Platelets 450×109/l
- Bilirubin 52μ/l
- What complication of transfusion has happened?
- What investigations would you do now to confirm?
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