Peyman Bizargity

Patient inclusion in transfusion medicine: current perspectives

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php International Journal of Clinical Transfusion Medicine 2015:3 7–16 International Journal of Clinical Transfusion Medicine Dovepress

Hot and Cold

A 5-year-old boy presents to the emergency department (ED) with 2 days of fever (temperature 100.7 °F), fatigue, jaundice, and dark urine. The parents note that the child had symptoms of a viral upper respiratory illness 2 weeks before presentation and that he was previously healthy with no history of blood transfusion. In the ED, the child weighs 21.3 kg, and laboratory workup reveals severe anemia with hemoglobin (Hgb) 5.4 g/dL, elevated total bilirubin 5.1 mg/dL, aspartate aminotransferase (AST) 357 U/L (normal range, 8–60 U/L), and lactate dehydrogenase (LDH) 8126 U/L. Serum haptoglobin is undetectable. Urinalysis results are as follows: color, dark; red blood cells (RBCs), 0–3 per high-power field; and urine Hgb, 3+ positive. Notably, the onset of symptoms (fever, fatigue, jaundice, dark urine) was associated with eating a bowl of ice cream. An ethylenediaminetetraacetic acid (EDTA) anticoagulant type and screen sample is submitted to the blood bank along with a request for RBC transfusion.

The “Unfraction” Reaction

An 8-year-old boy with congenital heart disease is admitted to the hospital for a planned mitral valve repair and revision. The patient has had multiple admissions to the hospital for surgery and complications relating to the congenital heart condition, most recently 1 month ago, and has required support with multiple transfusions of blood products over the years. His prior blood bank tests show that he is group A-positive with a negative antibody screen. A type and screen sample (ethylenediaminetetraacetic acid [EDTA] anticoagulant) is submitted to the blood bank along with a request for crossmatch of two units of red blood cells (RBCs).

I “Pitty” Thee

A 74-year-old man is admitted to hospital for workup of gastrointestinal (GI) bleeding; he is scheduled for colonoscopy the following day. An ethylenediaminetetraacetic acid (EDTA) anticoagulant sample is submitted to the blood bank for type and screen.

How “Dara” You!

A 73-year-old man with immunoglobulin (Ig)G kappa multiple myeloma is referred for outpatient transfusion due to severe anemia with hemoglobin (Hgb) of 6.6 g/dL. The patient has a history of red blood cell (RBC) transfusion at your hospital 2 years ago at which time the antibody screen was negative. An ethylenediaminetetraacetic acid (EDTA) anticoagulant sample is submitted to the blood bank for type and screen along with a request for two units of irradiated RBCs.

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.

Thromboelastography, My Dear Doctor

A 63-year-old man with a history of myocardial infarction and unstable angina is scheduled for coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). A preoperative ethylenediaminetetraacetic acid (EDTA) anticoagulant sample is submitted to the blood bank for type and screen along with a request for crossmatch of four units of red blood cells (RBCs) in preparation for the surgery.

Holy Cow! (“I’m Bloodless”)

A 59-year-old female, a self-described homemaker, and a mother to three children presents to the emergency department (ED) with acute-on-chronic anemia secondary to lower gastrointestinal (GI) bleeding (the patient is known to have a history of colonic diverticular bleeding) and iron deficiency. The patient takes iron and vitamin supplements at home. She additionally takes warfarin due to a history of atrial fibrillation. The patient’s hemoglobin (Hgb) level is 6.4 g/dL in the ED, and the patient appears pale with tachycardia (heart rate 110 beats/min) though her blood pressure is stable at 130/80 mmHg and her oxygen saturation is normal (98%) on room air. A type and screen sample (ethylenediaminetetraacetic acid [EDTA] anticoagulant) is submitted to the blood bank along with a request for crossmatch of two units of red blood cells (RBCs).

The Red Pee

A 55-year-old man with B-cell lymphoma and history of a warm autoantibody and a cold autoanti-I antibody reactive at 4 °C but no alloantibodies is admitted to the hospital for workup of fever of unknown origin. The patient has received red blood cell (RBC) and platelet transfusions in the hospital in the past but none in the prior 3 months. An ethylenediaminetetraacetic acid (EDTA) anticoagulant sample is submitted to the blood bank for type and screen along with a request for crossmatch of one irradiated RBC unit; the patient’s hemoglobin (Hgb) is noted to be 7.0 g/dL at the time of the request.

Passengers and Hitchhikers

A 54-year-old woman with hepatitis C cirrhosis, status post deceased-donor orthotopic liver transplant 14 days ago, returns for outpatient follow-up with complaints of excessive fatigue, lightheadedness, and dyspnea on exertion. The patient had experienced an uneventful postoperative course and was discharged from the hospital in good condition on postoperative day #4. Laboratory studies show that the hemoglobin (Hgb) has decreased from 9.1 (hospital discharge) to 5.1 g/dL. A type and screen sample (ethylenediaminetetraacetic acid [EDTA] anticoagulant) and a request for two units of red blood cells (RBCs) are submitted to the blood bank.