Westchester Medical Center Valhalla, New York, United States
Background/Case Studies: Blood transfusion is one of the most commonly used therapeutic modalities for anemia management in a hospital setting particularly in a trauma setting. Transfusion reactions are serious adverse events of blood transfusions that are assessed with a low threshold and high suspicion for reporting. Future transfusion management strategies such as premedication, product modification, and likewise depend on the accurate classification of the reaction. There are no previously reported instances of factitious transfusion reaction reported in the literature. This case report provides a clinical instance and discusses the importance of the workup in this setting.
Study
Design/Methods: We present a rare case report of repeated instances of unexplained transfusion reaction. We also did an English language literature review; similar cases were not identified.
Results/Findings: A 39 year old incarcerated male came to the ED for blood loss due to self-injury. Patient’s hemoglobin was 6.5, A positive blood group and a negative screen. 1 unit of RBC was issued and started for transfusion. Patient reported itching, chest pains and shortness of breath. Transfusion was stopped and reaction work up commenced. The visual hemolysis, clerical checks, post Screen and DAT were negative. Oxygen saturation and BNP was normal, chest x ray did not show any evidence of fluid overload or lung injury. No other symptoms such as facial or ocular swelling, hoarseness, wheezing or any vital sign changes were reported. Patient’s history was significant for a single instance of transfusion at the same hospital with similar reaction symptoms reported. The previous reaction was assessed as not related to transfusion. Clinical documentation showed there was suspicion for malingering. Conclusions: Close coordination between primary team and TM team, timely reporting of the reaction symptoms, and though laboratory testing assessment of all the symptoms is required even for a patient with well documented history of previous malingering of transfusion reaction symptoms. Any reported transfusion reaction, even in a patient with known history of malingering, should have a low threshold for full workup and high degree of suspicion of a true transfusion reaction. Ultimately, close clinical coordination with the blood transfusion team combined with a thorough transfusion reaction assessment and accurate documentation are all essential for suspected instances of malingering.
