A25-14 Acute Pulmonary Hemorrhage in a Neutropenic Patient: Transfusion-related Lung Injury (TRALI) vs Invasive Aspergillosis
Abstract
We present a case of acute pulmonary hemorrhage in a patient with chronic lymphocytic leukemia (CLL) after a blood transfusion. Autopsy revealed concern for invasive aspergillosis.
A 64-year-old man with a history of CLL, not on maintenance therapy, was admitted for neutropenic fever due to sinus infection and was started on piperacillin/tazobactam. Due to hypogammaglobulinemia, he received intravenous immunoglobulin. He was also resumed on neutropenic prophylaxis with acyclovir, fluconazole, and levofloxacin. His condition gradually improved, and on day nine of hospitalization, he was stable for discharge. Before discharge, one unit of packed red blood cells was ordered for hemoglobin <8 g/dL. Approximately 20 minutes after transfusion, he developed supraventricular tachycardia with heart rates in the 200s, requiring IV metoprolol and adenosine for rate control. Chest X-ray was unremarkable. He subsequently developed acute respiratory distress requiring escalation to the intensive care unit for intubation and mechanical ventilation. Bronchoscopy revealed bilateral large-volume bloody frothy secretions from all lobes of the lungs. The patient rapidly deteriorated and developed refractory shock requiring multiple vasopressors, multiorgan failure, metabolic acidosis, and anuria. He expired six hours after the transfusion. Autopsy demonstrated bilateral pulmonary hemorrhage, diffuse alveolar hemorrhage, and angio-invasive aspergillosis.
There was uncertainty regarding the cause…
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