Transfusion Reactions (part 1)
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Cancer and Blood Center at Kansas Institute of Medicine, Lenexa, KS

Question 1 of 5

A 72-year-old woman is admitted following a motor vehicle accident. Past medical history includes mild renal insufficiency, atrial fibrillation, hypertension, and diabetes. She is currently taking lisinopril, warfarin, and glyburide. Laboratory test result values include: white blood cell count (WBC) 12,000/µL, hemoglobin 7.4 g/dL, platelets 256,000/µL, and INR 4.86.

Emergent splenectomy is performed following splenic laceration. Six natural children are available for directed donation. The patient receives 7 units of red blood cells (RBCs) from unrelated ABO-compatible donors and 2 L of fresh frozen plasma (FFP). Her immediate postoperative course is unremarkable, and she is receiving continuous intravenous fluids. Eight hours later, nursing reports progressive dyspnea and tachycardia. She has no fever or sputum production. Examination reveals an oxygen saturation of 90% by pulse oximetry, heart rate of 106 beats/min, blood pressure of 160/90 mm Hg, jugular venous distention, 2+ bilateral lower extremity edema, no calf tenderness, and palpable liver. Chest radiograph demonstrates bilateral small pleural effusions and hilar infiltrates.

What is the most appropriate next step in the management of this patient?

Broad-spectrum antibiotics

Empiric anticoagulation and computed tomography angiography

Furosemide

Oxygen, conservative management

Steroids

Hospital Physician: Hematology/Oncology. 2019 March;14(3)

This quiz is not accredited for CME.

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