Transfusion Reactions – Clinical Case 2

A 70-year-old lady is brought in to the Emergency Department with an unstable pelvic fracture following a fall from a loft ladder. Her past medical history includes renal impairment, osteoporosis and a myocardial infarction two years ago.

She is tachycardic and hypotensive and is transfused two units of red cells and two units of fresh frozen plasma (FFP). She is kept nil by mouth whilst awaiting transfer to theatre for fixation and is also given 2 L of IV Hartmanns solution in the interim.

Five hours later, she reports feeling severely short of breath and her observations are as follows; RR 28, SpO2 88% on air, HR 112, BP 140/90 and T 36.5 C. On examination she has widespread crackles on auscultation, a raised JVP and pitting oedema to the ankles bilaterally.