Transfusion Medicine Case Studies

CASE 3: Complications Encountered

Clinical History:

You are nearing the end of your three month surgical rotation and are spending two weeks on the Orthopedic Service. A 50-year-old woman is an a.m. admit for total hip replacement following an accidental fall at home. You notice that she has a CBC which includes: hematocrit 35%, WBC count 8000/microliter, and platelet count 30,000/microliter. Concerned about the low platelet count, you call this result to the attention of your resident, who refers you to an Internal Medicine physician's pre-operative workup in the patient's medical record. You discover the following: (1) this patient has a long history of chronic alcoholism that includes one hospitalization two years ago for upper GI bleeding, and (2) the physician has recommended platelet transfusion prior to surgery.

  1. What additional history do you want?

  2. You need to know if this woman has been pregnant or transfused before. She may have HLA antibodies and will not respond to random platelet transfusions. This could be a bloody procedure without appropriate platelet support. If HLA antibodies are found, find out if the transfusion service can support this ptient prior to taking her to surgery.

  3. Why are you nervous about taking this patient to the OR?

  4. You also want to be sure of the cause for the thrombocytopenia. It could be the alcoholism, a large spleen, or something else. Be sure that the workup for the thrombocytopenia was thorough. Idiopathic thrombocytopenic purpura (ITP) can occur in persons with a history of alcohol abuse!