- A 73-year old woman, with a history of two pregnancies and no known red cell transfusions, was admitted to hospital with heart failure. She had myetodysplastic syndrome and mild renal failure. Her haemoglobin (Hb) concentration was 75 WI_ and two units of red cells were cross-matched and transfused. On day 19 after the first transfusion, two further red cell units were transfused matched as her Hb had dropped to 72 g!L.The second transfusion was interrupted 2.5 hours after being started because she experienced chills, lumbar pain and a temperature of 39.5DC.
a. List four possible reasons for the second transfusion. (10 marks) b. Discuss the differential diagnosis of the symptoms during the second transfusion. (40 marks) c. List the laboratory investigations required and explain why you would do them. (50 marks) - A patient with acute myeloid leukaemia (AML) was 9 months post stem cell transplant, with graft versus host disease (GvHD) and receiving frequent transfusions of red cells. Within an hour of starting the first unit, the patient developed rigors and back pain, was hypotensive and passed red urine. The pm-transfusion Hb of 69g!L fell to 430_ post reaction, suggesting haemolysis of the patient’s circulating red cells in addition to those just transfused. The patient had received 7 units of red cells during the previous 9 days. The patient’s renal function had started to deteriorate the day before the current transfusion.
a. Discuss the differential diagnosis of this transfusion reaction(s) and list the laboratory investigations required and explain why you would do them.
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