Marilyn Telen, MD Duke University Case Study #2 Marilyn Telen, MD Duke University

Case History The patient is a 70 year old woman with a prior diagnosis of iron deficiency anemia for which she received 3 units of RBC's one month ago. She has been prescribed oral iron, but she is only taking it rarely due to constipation. She now presents to the Emergency Department for progressively increasing fatigue.

Results

Questions Why is this patient's hemoglobin the same as it was one month ago? Has the patient had a transfusion reaction?

Explanations She now shows no benefit from the RBC one month ago, although the lifespan of normal RBCs is ~120 days and of transfused RBCs at least half that and usually longer. Therefore there must have been some kind of RBC destruction. She has had a delayed hemolytic transfusion reaction.

What now? Does she need treatment for a transfusion reaction? Can you safely transfuse her? YES, if you provide antigen negative (Jka-, e-) blood. This patient may form additional antibodies, as she has proven herself to be a “responder.”