A Case Report: Acute Respiratory Distress in a Patient with Anemia

Case Report

J Fam Med. 2021; 8(6): 1262.

A Case Report: Acute Respiratory Distress in a Patient with Anemia

Kotnala S, Wadhawan S and Parmar GM*

University of North Dakota Family Medicine Residency Program, Sanford Health, Fargo, ND 58122, USA

*Corresponding author: Parmar GM, Department of Family and Community Medicine, University of North Dakota (UND) School of Medicine and Health Sciences, UND-Sanford Fargo Family Medicine Residency Program, 801 N. Broadway, Fargo, ND 58122, USA

Received: May 13, 2021; Accepted: June 24, 2021; Published: July 01, 2021


Acute respiratory distress can be life threatening if proper management is delayed. The cause of respiratory distress needs to be diagnosed quickly in order to administer appropriate and timely treatment. However, it is sometimes difficult to tease out various conditions that can present as acute respiratory distress. We present such a unique case of acute respiratory distress in a patient with anemia. We show how the ability to differentiate between cardiogenic and non-cardiogenic pulmonary edema can help in diagnosis and appropriate timely management of acute respiratory distress.

Keywords: Pulmonary edema; ARDS; TRALI


TRALI: Transfusion Related Acute Lung Injury; RBC: Red Blood Cells; ABG: Arterial Blood Gas; BNP: Brain Natriuretic Peptide; TSH: Thyroid Stimulating Hormone; BiPAP: Bi-level Positive Airway Pressure; SARS-Cov-2: Severe Acute Respiratory Syndrome associated Corona Virus-2; COVID-19: Coronavirus Disease-19; ARDS: Acute Respiratory Distress Syndrome; RT-PCR: Reverse transcription polymerase chain reaction; PE: Pulmonary Embolism; HLA: Human Leukocyte Antigen

Case Presentation

A 65-year-old man with past medical history of hypertension and persistent atrial fibrillation presents with weakness, exertional dyspnea, and black-tarry stools for last 3-4 days. He denied chest pain, cough, fever, nausea, vomiting, or abdominal pain. He denied exposure to any sick contact or any recent national or international travel. He has been a never smoker and doesn’t use alcohol. He is on Rivaroxaban for anticoagulation for atrial fibrillation. Physical examination was unremarkable with normal heart sounds, no murmurs, no rales, no jugular venous distention, clear lungs, and no hepatosplenomegaly. He was found to have hemoglobin of 6.7 mg/ dL and was transfused one unit of packed RBC, which improved his hemoglobin to 8.9 mg/dL. He developed acute respiratory distress and hypoxia immediately after transfusion. His oxygen saturation dropped to 70%. His ABGs were pH of 7.35, PCO2 of 36, PO2 of 71, and HCO3 of 19 on BiPAP with FiO2 of 100%. His BNP was 300. Previous echocardiogram one month ago was unremarkable with ejection fraction of 65%. TSH was with-in-normal limits. SARSCov- 2 testing was negative. Furosemide treatment was minimally effective. His initial Chest X-Ray (CXR) on arrival is shown in panel A and subsequent CXR is shown is Panel B (both CXRs are two hours apart) (Figure 1). Patient has provided informed consent.

What is the diagnosis?

• Flash Pulmonary Edema from Congestive Heart Failure

• Aspiration Pneumonia

• ARDS from Covid-19

• Transfusion Related Acute Lung injury (TRALI)

• Pulmonary Embolism


• The correct answer is Transfusion-Related Acute Lung Injury (TRALI) is a non-cardiogenic pulmonary edema after a blood product transfusion without other explanation [1]. There is no other reasonable explanation for bilateral pulmonary infiltrates in our patient other than TRALI (see below). CXR in panel-A and panel-B are only 2 hours apart (Figure 1), TRALI manifests within 6 hours of receiving a blood product [2]. It occurs in about 1 in 5000 transfused blood products and allogeneic antibodies to leukocyte/HLA are found in about 80% cases as well as no antibodies are identified in 20% cases [3]. 10-20 % female blood donors and 1-5 % male blood donors have anti-leukocyte antibodies in their serum3. There is no specific treatment available, only supportive care. Our patient’s reaction was reported to blood blank and subsequent testing for antileukocyte antibodies was negative. Patient recovered with supportive care and discharged home after three days of hospital stay.

Citation:Kotnala S, Wadhawan S and Parmar GM. A Case Report: Acute Respiratory Distress in a Patient with Anemia. J Fam Med. 2021; 8(6): 1262.