20th February 2025

A 41-year-old woman is having a unit of red blood cells transfused for symptomatic anaemia.

A 41-year-old woman is having a unit of red blood cells transfused for symptomatic anaemia. She has a past medical history of iron-deficiency anaemia and menorrhagia secondary to uterine fibroids. Her initial observations are unremarkable and she is otherwise feeling well apart from her anaemic symptoms.

The transfusion is uneventful. However, 2 hours after the transfusion finishes, she gets very breathless and feels unwell. Her blood products are rechecked and confirmed to be the correct blood for the patient. Her observations are respiratory rate of 36 breaths per minute, oxygen saturations of 94% on 36% venturi mask, blood pressure of 88/59 mmHg, heart rate of 130 beats per minute, temperature of 38.2°C. On examination, she is clammy, in respiratory distress and has bilateral crackles on lung auscultation. Both heart sounds are heard and no added sounds. Her JVP is not elevated and there is no peripheral oedema. She is stabilised with a 250 mL fluid bolus and chest radiograph shows bilateral central infiltrates. 

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