1. Presented by Eric A. Gehrie, MD and prepared by Lorraine N. Blagg, MA, MLS(ASCP)SBB

Clinical Vignette

An adult with newly diagnosed acute myeloid leukemia was transfused two RBC units at an outside hospital three days prior to admission at your hospital. Upon admission, the patient has a hemoglobin of 7.9 g/dl, 0.03 K/cu mm nucleated RBCs, 13% blasts on WBC differential, acanthocytes and schistocytes on blood smear, LDH of 1078 U/L, and moderate hemoglobin in his urine (hemoglobinuria). A type and screen and two RBC units are ordered. The patient types as an O Positive and has a positive antibody screen.

Question:
Given the patient's history and laboratory findings, which of the following is of concern?