Of Wind and Water
A 65-year-old man with a history of obesity, type 2 diabetes mellitus, chronic anemia, and renal insufficiency is admitted to the hospital for evaluation of worsening renal failure, a drop in the hemoglobin (Hgb) level, dyspnea on exertion, and fatigue. The patient’s Hgb is 6.2 g/dL (his baseline is 8.0 g/dL), and the creatinine is 4.4 mg/dL on admission. The patient is tachypneic (respiratory rate is greater than 20 breaths/min) and hypoxic (oxygen saturation is 88% on room air). He is treated with supplemental oxygen 2 L/min by nasal cannula and normal saline by slow intravenous (IV) infusion (125 mL/h). A consult is called for evaluation of gastrointestinal bleeding. In the meantime, a type and screen sample (ethylenediaminetetraacetic acid [EDTA] anticoagulant) is submitted to the blood bank along with a request for two units of red blood cells (RBCs). The patient received RBC transfusion of two units 3 years ago at the hospital; the antibody screen was negative at that time.
KeywordsAcute lung injury/ALI Adult respiratory distress syndrome/ARDS Biologic response modifiers (BRMs) Brain natriuretic peptide/BNP HLA antibodies Human neutrophil antigen antibodies Transfusion-associated circulatory overload/TACO Transfusion-related acute lung injury/TRALI
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