A 32 year old G1P1 patient has delivered her first child with the complication of severe postpartum hemorrhage. She has required 2 units of pRBCs; however, one hour post her second unit she starts to complain of fever, tachycardia, dyspnea and has crackles on her chest exam.
What is the differential diagnosis of her condition? How should she be managed?
Points for discussion:
The differential diagnosis of acute dyspnea post transfusion is broad and includes: Pulmonary embolism, infection, TRALI, TACO, AHTR, and anaphylaxis.
This patient should be kept in a monitored setting, with IVF and oxygen given. Immediate investigations include CXR, ABG, septic work-up (i.e. blood cultures), CBC, group and screen, and hemolytic indices (retic count, LDH, haptoglobin).
The blood bank should be immediately notified to investigate for transfusion-related pulmonic causes, such as TRALI and complete blood cultures, on the transfused sample.