Pathology Notes

Practice questions Blood transfusion II © Jun Wang, MD, PhD   1. Use this case for the next five questions . A 36-year-old B- woman is undergoing an emergency laparotomy for a ruptured ectopic pregnancy. 2 B- units of packed red blood cells are ordered. Twenty minutes into the transfusion, she develops chills, fever and back pain. Her blood pressure drops from 110/70 mm Hg to 80/50 mm Hg.   Her temperature raised from 37 ° C to 39.5 ° C. Examination reveals generalized flushing and oozing at the surgical site. Laboratory studies show: Hemoglobin: 7.8 g/dL (prior to transfusion: 9.2 g/dL) LDH: 1,200 U/L (normal: 100–220 U/L) Total bilirubin: 4.8 mg/dL Haptoglobin: <10 mg/dL What is the most appropriate next step in management of this patient? A. Antihistamines B. Antipyretics C. Broad spectrum antibiotics D. Clerical check of the patient and blood units E. Epinephrine F. Stop transfusion     2. A 36-year-old B- woman is undergoing an emergency laparoto...

Practice questions answers Blood transfusion II © Jun Wang, MD, PhD   1. F. This patient has acute onset of new symptoms during blood transfusion, highly suspicious for transfusion reaction. Regardless of type of transfusion it is, the first thing need to do is to stop transfusion. Others, including clerical check, can be performed after transfusion is stopped.  2. C. This case is characterized by acute onset of fever, chill, back pain and hypotension. The laboratory findings of high LDH and bilirubin and low levels of haptoglobin are consistent with hemolysis. The presence of blood oozing at surgical site is most likely due to hemolysis caused DIC . These presentations are most likely acute hemolytic transfusion reaction , caused by immune hemolysis resulted from blood type incompatibilities. Direct Coombs test examine antibodies or complements attached to RBC surface, and is positive with immune hemolysis . Anti-H lectin test is used examine the lack of H substan...