Transfusion Medicine Case: A 58yo Woman with History of Colon Cancer Presents with Epigastric Pain – Clinical Pearl of the Month

Gerard Kiernan, MD, FAAFP, FHMClinical Pearls, Emergency Medicine, Family Medicine, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Pediatric Medicine, Personal Education, Physician Assistant, Urgent Care

Transfusion medicine case - A 58-year-old-woman with colon cancer presents with epigastric pain.

Transfusion Medicine Case: A 58-year-old woman with a history of colon cancer presents with intermittent epigastric pain.

Guidelines for Transfusion Pearls of Wisdom Q&A Case

Transfusion medicine (or transfusiology) is the branch of medicine that encompasses all aspects of the transfusion of blood and blood components including aspects related to hemovigilance. It includes issues of blood donation, immunohematology and other laboratory testing for transfusion-transmitted diseases, management and monitoring of clinical transfusion practices, patient blood management, therapeutic apheresis, stem cell collections, cellular therapy, and coagulation. Laboratory management and understanding of state and federal regulations related to blood products are also a large part of the field.

Let's glean a pearl of wisdom for  this transfusion medicine case...

A 58-year-old woman with a history of colon cancer successfully treated with neoadjuvant chemotherapy and surgery five years ago presents with intermittent epigastric pain. 

She describes the discomfort as an ‘ache’ in the epigastrium accompanied by pyrosis, made worse by large meals and by lying down in bed. She has had no fever, chills, or weight loss.

She smokes a half pack of cigarettes per day, and she drinks seven to ten alcoholic drinks per week. 

The patient has tried over the counter antacids with some symptom improvement.

She has never previously had a blood transfusion reaction, and she has only received a blood transfusion once, after her colon resection.

On examination, she has normal vital signs, some scattered pulmonary wheezes, and mild tenderness on epigastric palpation. She has some pallor on conjunctival and skin exams.

Blood tests show that her hemoglobin is 8 g/dL (normal female range12-16 g/dL) and the Mean Cell Volume (MCV) is 60 µmm3 (normal range 80-100 µmm3)

The patient is started on a proton pump inhibitor and referred for endoscopy.  


Which of the following is true regarding the use of blood products in this patient?

Answer Options:

Transfuse one unit of irradiated packed red blood cells.

Transfuse two units of packed red blood cells.

Transfuse one unit of packed red blood cells.

No transfusion is indicated.

See the Answer:

About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.

About Clinical Pearl of the Month:

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About Med-Challenger:

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Transfusion Medicine patient case - A 58-year-old woman with a history of colon cancer successfully treated with neoadjuvant chemotherapy and surgery five years ago presents with intermittent epigastric pain. -

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