| Patient: __ | ID: __ | DX: Status post mitral valve repair |
| Clerical Accuracy Confirmed: | Patient identification of samples - _X_ Requisition - _X_ Donor Units - _X_ |
|
| Previous Reaction: | No | |
| Product Administered: | 2 units of packed RBC’s | |
| Date/Time of Reaction: | --/-- | |
| Symptoms: | Increased fever (38.2 C to 39.2 C), hoarseness, facial edema, and elevated systolic blood pressure to 110 mmHg | |
PRELIMINARY |
Date/time |
Direct |
Plasma Hgb |
Hemoglobinuria |
Pre-reaction Specimen |
-- / -- | NT | NT | NT |
Post-reaction Specimen |
-- / -- | Neg | NH | NA |
Specimen sent for culture? |
Yes |
Results: |
NEGATIVE |
|
(NT = not tested; NH = no hemolysis; NA = not available) |
||||
CONCLUSION OF THE CASE INVESTIGATION
