A 45 year old woman was admitted to the hospital for a hysterectomy. The patient

Question

A 45 year old woman was admitted to the hospital for a hysterectomy. The patient had been pregnant four times and had no history of transfusions. She was taking no medications. The patient’s admission CBC revealed a low hgb of 7 g/dl. The physician ordered a unit of RBCs to be given before surgery to correct her anemia before an elective hysterectomy. Lab tests: A unit of group 0 positive RBCs was crossmatched and found compatible. The patient’s antibody screen test result was negative. Hospital Course: A transfusion of group 0 positive compatible RBCs was begun at 1:45pm and given through a standard 170 um blood infusion set. After receiving approximately half of the RBCs, the patient experienced chills, and her temperature rose from a pre-transfusion temperature of 37.2 C to 39.4 C. She had a severe headache and felt anxious and uncomfortable. The blood transfusion was stopped and the patient’s physician notified. A transfusion reaction investigation was initiated. Lab Findings: No clerical errors found. Examination of the patient’s pretransfusion and posttransfusion blood and urine specimens revealed no visible hemolysis. The DAT result on the post-transfusion blood specimen was negative. No RBC alloantibodies were detected in the serum of the patient or the donor. Repeat blood typings and crossmatch tests on the pretransfusion and posttransfusion specimens and donor unit confirmed the original test results. No incompatibility was demonstrated. Results of the serum bilirubin test 5 hours after the transfusion were normal. Bacterial contamination was ruled out by a negative culture and Gram stain. Question: Please provide a complete explanation of what has occurred here.

Explanation / Answer

Circulatory overload might have occured due to distended neck veins or peripheral edema in patient. Due to allergic reactions with blood given increases temperature.

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