Question about blood transfusions and H/H

Recently had a pt with an H/H level of 4 and 15. MDs were leery of transfusions because everytime she has been getting transfused her levels would drop even more. I know you can develop antigens overtime occasionally but the MDs were utterly confused by her predicament. Any thoughts??
Quote from Tobygo2 MDs were leery of transfusions because everytime she has been getting transfused her levels would drop even more.

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

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!

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.

Quote from Tobygo2Thanks 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.

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

Sickle cell?

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!

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. "

Quote from Tobygo2Wbcs 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!