Distressed

A 60 year old man with a history of intermittent rectal bleeding for several months is admitted after his hemoglobin level is found to be 5.5 g/dL. He is not bleeding at the time of admission.

A single unit of packed red cells is transfused cautiously over 4 hours, with a single dose of furosemide administered mid-transfusion.

Half an hour after the transfusion he started to complain of breathlessness, fever and profuse sweating.

Select Relevant Investigations
Chest X-Ray

Performed

Bilateral pulmonary infiltrates are noted. The cardiac silhouette appears normal.
Arterial Blood Gases

Performed

FiO2: 60% (on oxygen via face mask)
PO2: 60 mmHg
PCO2: 35 mmHg
pH: 7.36
HCO3-: 22 mmol/l
SaO2: 83%
Full Blood Count + DAT

Performed

WBC/DC: 7,000/mm3
Hb: 7 mg/dL
Hct: 25%
Platelets: 350,000/mm3
Direct Antiglobulin Test: negative
ECG

Performed

The ECG appears completely normal.

Select Relevant Management
CPAP Ventilation
Diuretics
Nebulize with Adrenaline
Antibiotics