A 45-year-old male was admitted with life threatening shock after being involved in a motor vehicle accident, requiring emergency surgery with large volume blood loss. Post-operatively following return to ICU, he was noted to become hypotensive, febrile and oozy from various drip and operative sites. Red urine was noted.
The following blood results were obtained:
|Parameter||Patient Value||Adult Normal Range|
|Haemoglobin||87 g/L*||120 - 160|
|White Cell Count||18.9 x 109/L*||4.0 - 11.0|
|Platelet count||132 x 109/L*||150 - 350|
|Sodium||138 mmol/L||135 - 145|
|Potassium||4.3 mmol/L||3.5 - 5.0|
|Chloride||102 mmol/L||95 - 105|
|Bicarbonate||20.0 mmol/L*||22.0 - 26.0|
|Glucose||5.3 mmol/L .||3.5 - 6.0|
|Urea||15.2 mmol/L*||3.0 - 8.0|
|Creatinine||80 µmol/L||45 - 90|
|Creatinine Kinase||2000 U/L*||55 - 170|
Urine Myoglobin: trace
Urine Haemoglobin: ++
Based on his clinical history and the lab report (shown on page 7), what is the likely cause of his post-operative deterioration? How will you confirm your diagnosis?
Check patient’s and donor groups and re check cross match.
A systematic discussion of the results:
Overall everything points to an acute haemolytic transfusion reaction. It would have been nice for the college to offer a picture; the urine of haemoglobinuria is classically bright red but translucent, in contrast to the muddy clot-filled haematuria which might result from some sort of renal trauma.
To confirm the diagnosis, the Australian Red Cross recommends the following steps: