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?
– NO
• 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.”