25th July 2024

A 65-year-old gentleman is admitted with an upper GI bleed. He has a background of alcoholic liver disease

A 65-year-old gentleman is admitted with an upper GI bleed. He has a background of alcoholic liver disease, T2DM and alcoholic cardiomyopathy with a left ventricular ejection fraction (LVEF) of 30%.

He is haemodynamically stable on admission, however he has a haemoglobin of 62 g/L, and he is therefore transfused 3 units of RBC, each over 2 hours. During the third unit of RBC, you are called to review the patient. He is afebrile, with oxygen saturations of 86% on room air, RR 28/minute, HR 102 bpm, BP 92/44 mmHg. On examination, there are no obvious rashes or swellings, his airway is patent, he has bilateral crackles on auscultation of the chest, his JVP is not elevated and he has no peripheral oedema. Portable chest X-ray shows bilateral pulmonary infiltrates.

What is the most likely underlying cause of this patient’s deterioration?

Select the SINGLE most appropriate option from the list below. Select ONE option only.