Contributed by Nathan Cook MD and Alesia Kaplan MD
A 60-70 year old male patient with a history of prostate cancer presented to the ED after being informed that they had abnormal findings on blood work drawn the previous day at their oncology appointment. Lab results showed a hemoglobin of 6.8. The patient denied any symptoms, including fatigue, dizziness, lightheadedness, chest pain or shortness of breath. The patient reported having consistently low hemoglobin values since receiving chemotherapy the previous year. A review of the patient's lab revealed a recent downward trend in the patient's hemoglobin values.
The patient was admitted for RBC transfusion and received one unit of leukoreduced RBC over 1.5 hours. Ten minutes following transfusion, the patient developed dyspnea and increased oxygen requirements, hypertension, tachycardia and tachypnea. Vital signs were as follows:
The patient was transferred to the ICU with worsening respiratory status and was intubated. CXR showed new pulmonary vascular congestion and airspace consolidation. The following morning, CXR findings were resolved and the patient was successfully extubated. Blood bank laboratory workup for hemolysis was negative.
DIAGNOSIS and DISCUSSION