Question about blood transfusions and H/H

Guttercat, ASN, RN · Nov 23, 2013

MDs were leery of transfusions because everytime she has been getting transfused her levels would drop even more.

My intial thoughts (based on the very limited info you provide here) is that they have run every antibody/immunologic test known to mankind.

Interesting case. Any other info you can provide?

Altra, BSN, RN · Nov 23, 2013

I'm assuming they have ruled out active bleeding ... (GI, etc.)

calivianya, BSN, RN · Nov 23, 2013

It sounds like a hemolytic transfusion reaction, if everyone's sure she's not just bleeding excessively from somewhere and that the transfusion is actually at fault. That's all I can think of!

Tobygo2 · Nov 23, 2013

Thanks everyone! I only had her for half a shift but she really got to me as she's a young, otherwise healthy girl. Definitely no gi bleed and no active bleeding anywhere else. We wanted to transfer her to the main big daddy hospital in the state but of course they don't have any empty beds. I just hope she'll be ok! At first when I saw her counts I thought leukemia but then everything else came into play.

KelRN215, BSN, RN · Nov 23, 2013

Thanks everyone! I only had her for half a shift but she really got to me as she's a young, otherwise healthy girl. Definitely no gi bleed and no active bleeding anywhere else. We wanted to transfer her to the main big daddy hospital in the state but of course they don't have any empty beds. I just hope she'll be ok! At first when I saw her counts I thought leukemia but then everything else came into play.

What was her WBC count? Platelets?

Esme12, ASN, BSN, RN · Nov 23, 2013

Wow 15/4 that's low...they are sure she has no active bleeding? Is she symptomatic? what's the differential?

TU RN, DNP, CRNA · Nov 23, 2013

Sickle cell?

Tobygo2 · Nov 24, 2013

Wbcs were 16. Platelets 275. She wound up going to ICU after she had chest pain during her transfusion She's stable from what I've heard but they still don't know what is causing this this. She's so young it just breaks my heart!

nurseprnRN, BSN, RN · Nov 24, 2013

Sent a link to this thread to my hematology guru, and she replies:

"Okay, sounds like a hematopoetic stem cell problem. As you might recall, bone marrow is the primary organ for new cell development. Although pt was transfused, it is merely a bandaid if he/she can't produce new cells released from marrow into circulation. Remember, an H/H is a peripheral blood test. If it is very low, despite transfusion, gotta go to the root of the problem: the stem cells in the marrow. That is where the cells are being produced, released into peripheral circulation where they differentiate into erythrocytes, granulocytes,thrombocytes, etc..Did MD do a bone marrow aspiration? Does pt have splenomgaly?

Depending on the etiology (a lot of info is missing), perhaps a stem cell transplant might be an option. "

KelRN215, BSN, RN · Nov 24, 2013

Wbcs were 16. Platelets 275. She wound up going to ICU after she had chest pain during her transfusion She's stable from what I've heard but they still don't know what is causing this this. She's so young it just breaks my heart!

How young? Young enough that she could have an undiagnosed genetic anemia? (I'm a pedi nurse, so when someone says "very young", I'm thinking infant.) WBC count is slightly elevated but not elevated enough that the count alone would make you think "leukemia." Does she have circulating blasts in her CBC? If so, that would point towards leukemia. Platelet count is also normal- I honestly don't think I've seen new onset leukemia with a normal platelet count before. (I could be wrong, I just don't think I've seen it.) Have they done a bone marrow biopsy? I'd be thinking something like Diamond Blackfan Anemia, in which WBC and Platelets are relatively normal and RBC, Hgb, Hct are very low. This is a very rare disease and usually diagnosed in the first two years of life.