The Perils of Transfusing the Sickle Cell Patient

Abstract

A 44-year-old female with sickle cell disease presents to the emergency department with acute pain crisis (pain in shoulders and upper back). The patient’s hemoglobin (Hgb) level is 7.2 g/dL, which is around her usual baseline Hgb. The patient received 2 red blood cell (RBC) units in the outpatient department of another hospital 4 days prior to admission (her Hgb level was 7.6 g/dL prior to transfusion at that time), and as per that hospital’s blood bank, the patient has an antibody history of warm autoantibody, anti-Fy^a, and anti-Jk^b. Overnight in the emergency department, the patient’s blood pressure dropped to 90/56 mmHg, and the Hgb level dropped to 5.4 g/dL with total bilirubin (T-Bili) level 15.3 mg/dL and the lactate dehydrogenase (LDH) level 10,000 U/L. The patient is admitted to the medical intensive care unit (MICU) and a type and screen sample (ethylenediaminetetraacetic acid, EDTA anticoagulant) is submitted to the blood bank along with a request for two units of RBCs.