Hemolytic transfusion reaction mimicked by occult retroperitoneal bleeding

Article (PDF Available)inTransfusion 53(3):482 · March 2013with19 Reads
DOI: 10.1111/j.1537-2995.2012.03844.x · Source: PubMed
Abstract
An 83-year-old male with coronary heart disease, aortic stenosis, and hypertension was admitted to the hospital with syncope and collapse. He had no visible signs of injury. Initial blood tests were normal, except for a hemoglobin (Hb) level of 12.8 g/dL (normal range, 14.0-18.0 g/dL). Preliminary diagnosis of cardiac syncope due to ventricular tachycardia was made. On Day 5, a decrease in Hb to 8.8 g/dL was detected and 2 units of RBCs were transfused. A few hours later, the patient complained about severe abdominal and back pain. Acute hemolytic transfusion reaction was suspected. Laboratory tests revealed signs of hemolysis, including twofold increase of lactate dehydrogenase (from 240 U/L to 436 U/L) and indirect bilirubin (from 1.3 to 2.8 mg/dL; normal range, <1.2 mg/dL), low haptoglobin (0.6 g/L; normal range, 0.3-2.0 g/L), and inadequate rise of Hb. Transfusion reaction evaluation, including antibody screen, cross-match testing, direct antiglobulin tests, and eluates performed from posttransfusion samples, did not reveal any incompatibility. With increasing pain, a CT scan was performed. A large retroperitoneal hematoma was discovered (see Figure; approx. loss of 1 L of blood). Because this patient was on dual antiplatelet therapy, hemorrhage was felt to be triggered by both antiplatelet therapy and the physical injury. To obtain adequate Hb levels, the patient received 6 additional RBC units. During follow-up, the size of the hematoma diminished and surgical intervention was not considered. Laboratory signs of hemolysis normalized within a few days. We conclude that suspected transfusion reactions should be evaluated urgently, because even negative findings can be helpful in redirecting the differential diagnosis and may impact patient care significantly. CONFLICT OF INTEREST None. kidney fat RPH fat PM RPH PM PM PM = psoas major muscle; RPH = retroperitoneal hematoma. Pictures by Prof. Dr. Klose, Radiology, Marburg.

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Available from: Sabine Flommersfeld, Sep 03, 2015
TRANSFUSION MEDICINE ILLUSTRATED
Hemolytic transfusion reaction
mimicked by occult retroperitoneal bleeding_3844482
Sabine Flommersfeld, Bernhard Maisch, Gregor Bein, and Ulrich J. Sachs
An 83-year-old male with coronary heart disease, aortic stenosis, and hypertension was admitted to the hospital with
syncope and collapse. He had no visible signs of injury. Initial blood tests were normal, except for a hemoglobin (Hb)
level of 12.8 g/dL (normal range, 14.0-18.0 g/dL). Preliminary diagnosis of cardiac syncope due to ventricular
tachycardia was made. On Day 5, a decrease in Hb to 8.8 g/dL was detected and 2 units of RBCs were transfused. A few
hours later,the patient complained about severe abdominal and back pain. Acute hemolytic transfusion reaction was
suspected.
Laboratory tests revealed signs of hemolysis, including twofold increase of lactate dehydrogenase (from 240 U/L to
436 U/L) and indirect bilirubin (from 1.3 to 2.8 mg/dL; normal range, <1.2 mg/dL), low haptoglobin (0.6 g/L; normal
range, 0.3-2.0 g/L), and inadequate rise of Hb. Transfusion reaction evaluation,including antibody screen, cross-match
testing, direct antiglobulin tests, and eluates performed from posttransfusion samples, did not reveal any incompat-
ibility.With increasing pain, a CT scan was performed. A large retroperitoneal hematoma was discovered (see Figure;
approx. loss of 1 L of blood). Because this patient was on dual antiplatelet therapy, hemorrhage was felt to be triggered
by both antiplatelet therapy and the physical injury. To obtain adequate Hb levels, the patient received 6 additional
RBC units. During follow-up, the size of the hematoma diminished and surgical intervention was not considered.
Laboratory signs of hemolysis normalized within a few days.
We conclude that suspected transfusion reactions
should be evaluated urgently, because even negative find-
ings can be helpful in redirecting the differential diagnosis
and may impact patient care significantly.
CONFLICT OF INTEREST
None.
kidney
fat
RPH
fat
PM
RPH
PM PM
PM =psoas major muscle;
RPH =retroperitoneal hematoma. Pictures by Prof. Dr. Klose,
Radiology, Marburg.
From the Center for Transfusion Medicine and Hemotherapy
and the Department of Cardiology, University Hospital Giessen
and Marburg, Campus Marburg, Marburg; and the Institute for
Clinical Immunology and Transfusion Medicine, Justus Liebig
University, Giessen, Germany.
Address reprint requests to: Sabine Flommersfeld, Center
for Transfusion Medicine and Hemotherapy, University Hospital
Giessen and Marburg, Campus Marburg, Baldingerstrasse,
35043 Marburg, Germany; e-mail: flommers@med.uni-
marburg.de.
Received for publication May 14, 2012; revision received
June 28, 2012, and accepted June 28, 2012.
doi: 10.1111/j.1537-2995.2012.03844.x
TRANSFUSION 2013;53:482.
482 TRANSFUSION Volume 53, March 2013
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