In the middle of a blood transfusion, the nurse notes coarse crackles throughout the lungs and poor aeration in the patient. He discontinues transfusion and suspects that the latter may be showing early signs of cardiogenic pulmonary edema.
He telephones Dr. Benner with the findings and with the doctor’s approval, he requests for an arterial blood gas (ABG) analysis, a complete metabolic panel to asses kidney function, an analysis of cardiac markers, a chest X-ray and an electrocardiogram (BCG) for the patient. The X-ray shows coarse alveolar infiltrates and normal heart size.
The laboratory test results are normal. The nurse, then, suspects transfusion related acute lung injury (TRALL), a condition which exhibits the same symptoms during transfusion but without signs of fluid overload such as edema. Dr. Benner orders a computed tomography (CT) scan which shows diffuse edema and inflammatory consolidation in the lung fields. The ABG results confirm that the patient did incur lung injury during the transfusion, a potentially fatal condition, but his life was saved because of a nurse who read the signals correctly and acted quickly.