Case 136 – the beginning

You are the haematology SpR holding the on-call phone. You are called by an orthopaedic SpR regarding a 71-year-old lady she has reviewed in clinic with significant osteoarthritis of the right hip. The patient’s mobility and quality of life have been so impacted that the team plan to expedite a total hip replacement in the coming weeks/months. In view of the patients FBC, they have requested a 2 unit RBC transfusion in the coming days to optimise the patient prior to surgery. Her FBC is below:

Hb       84 g/L

WCC    8.3 x 109/L

Plt        455 x 109/L

MCV    95.2 fL

MCH    29.0 pg

Neuts   5.9 x 109/L

Lymph 1.6 x 109/L

Mono 0.5 x 109/L

Eosin   0.2 x 109/L

Baso    0.1 x 109/L

The patient has a valid Group and Screen and is Group A Rh D +ve with a negative antibody screen. She has not been transfused previously.

The transfusion BMS has questioned the appropriateness of the transfusion and has requested that the clinical team discuss with yourself.

What clinical information would you request from the orthopaedic team?

What further tests would you request?

Would you authorise the transfusion?

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