Case 122

1. Presented by Caroline Early, MD and reviewed by Liz Crowe, MD

Clinical Vignette

The patient is an elderly man with a past medical history of colon cancer, end stage renal disease on hemodialysis, atrial fibrillation, and heart failure with reduced ejection fraction. He presented to the Emergency Department with melena and was found to have a hemoglobin of 6.9 g/dL requiring a red blood cell transfusion. When there was about 30 cc remaining in the bag, the patient was noted to have jugular venous distention, hypertension, dyspnea and hypoxia requiring oxygen supplementation via by nasal cannula. A chest radiograph was obtained (see image), which revealed bilateral infiltrates.

After initiating a transfusion reaction evaluation, which of the following is the BEST next step?