Case 103 – update 1

We have found out that our patient has just started adjuvant chemotherapy for breast cancer following surgery.

Five days prior to admission she had a 2 unit blood transfusion, which had no immediate complications.

She had no transfusions prior to this.

4 previous pregnancies with uncomplicated delivery. All babies were born at term with no jaundice or anaemia.

She self discharged from the urology ward and was given a course of antibiotics for a presumed UTI.

She attends her oncology day unit later that day for review following her chemotherapy. This is a different hospital to her local hospital where she attended for the haematuria. She mentioned that she had been feeling increasingly tired and had been admitted under urology for a blood transfusion and antibiotics following blood in her urine which had resolved on admission.

Her Hb is found to be 67g/l and her creatinine 288, with a bili of 106. She is admitted to the oncology ward for iv fluids and antibiotics and she is crossmatched and transfused 2 further units of blood, antibody screen negative. The lab has not been informed regarding the previous possible transfusion reaction. During the 2nd unit of blood she begins to feel very, but none specifically, unwell, and has some chills. She remains haemodynamically stable. The transfusion is stopped and the patient has piriton, hydrocortisone and paracetamol. The iv fluids are continued. The patient is catheterised and her urine again appears to be red.

Our patient has now had a total of 6 units of red cells transfused in the last 8 days. Following the most recent transfusion her bloods show –

Hb 80g/l

Plt 180

Wcc 11

Neuts 5.5

Urea 12

Creatinine 400

Bilirubin 90

Pt 14

Aptt 35

Fib 3.5

LDH 400

Retic 35 (50-100×109/l)

Haptoglobin undetectable

DAT negative

Blood cultures pending

What would you do next? Would you like any more information?

What do we think is happening?

Join us on Twitter @TeamHaem and let us know what your thoughts are, what questions you have and what you want to do as we see this case evolve over the next week. Remember to use #teamhaem on all your posts to help us follow the case! Please note โ€“ 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 and learning

About TeamHaem

Online education and discussion about all things haematological
This entry was posted in Uncategorised. Bookmark the permalink.