Contributed by Ashok Nambiar, MD and Ileana Lopez-Plaza, MD
Published on line in September 2001
The patient is a 60-year-old, white male with multiple medical problems. His past surgical history is remarkable for multiple lumbar back surgeries for treatment of chronic back pain, multiple knee replacements for degenerative joint disease, cholecystectomy, and numerous sinonasal surgeries for recurrent sinusitis. He is also status post prostatectomy for adenocarcinoma of prostate.
His past medical history is significant for recurrent nasopharyngeal, bronchial and urinary tract infections. He also has a history of hypothyroidism, reflux esophagitis and anxiety disorder.
On this admission, he presented to the Emergency Department with severe back pain. Imaging studies revealed lumbar canal stenosis and spondylolisthesis, and he was scheduled for L2-L5 decompression and fusion surgery. Significant blood loss was anticipated during surgery and the transfusion medicine service was asked to arrange for his blood component needs. Several years ago, he had a severe allergic reaction to blood products. An investigation of that problem led to his requiring special precautions when receiving transfusions, and since then he has been transfused several times without any adverse reactions.
|Blood Group||O Positive|
|Serum IgA||< 7 mg/dL (90-325 mg/dL)|
|Serum IgG1||544 mg/dL (500-1200 mg/dL)|
|Serum IgG2||262 mg/dL (200-600 mg/dL)|
|Serum IgG3||43 mg/dL (50-100 mg/dL)|
|Serum IgG4||15 mg/dL (50-100 mg/dL)|
Other routine biochemical and hematological tests, and coagulation profiles were within normal limits.