A 60-year-old man undergoing chemotherapy for acute myelogenous leukemia was receiving a red blood cell (RBC) transfusion because his hemoglobin had dropped to 7.5 g/dL. He had received 6 units of RBCs and 3 units of platelets during the preceding 4 months with no apparent incident. One hour after the transfusion began, with about half the unit infused, the patient became anxious, mildly short of breath, and a fever of 101.9°F developed. The transfusion was stopped at the onset of symptoms and the intravenous (IV) line was kept open with normal saline at 10 drops/minute. The RBC unit was sent to the blood bank with posttransfusion patient specimens for a transfusion reaction workup.
The patient's vital signs prior to the start of the transfusion and at the time of the reaction are outlined in Table 1.
Table 2 shows the results of the transfusion reaction laboratory workup.
Table 1. Vital Signs
|Vital Signs||Pretransfusion||Time of Reaction|
|Blood pressure||120/70 mm Hg||150/90 mm Hg|
Table 2. Transfusion Reaction Laboratory Workup Results
|Direct antiglobulin test||Negative||Negative|
What is the differential diagnosis for this patient's transfusion-associated fever? What is the most likely diagnosis considering the medical history and the transfusion reaction laboratory workup results?
Medscape Pathology © 2011 WebMD, LLC
Cite this: I Thought a Blood Transfusion Would Make Me Feel Better - Medscape - Mar 28, 2011.