Day +1 BMT

Early this morning, 1 pint of packed red blood cell was transfused because  the FBC count taken last night showed Hb is 7.1. Around 1 a.m, develop shortness of breath and was put on oxygen. The CXR done immediately showed pulmonary infiltrate and was treated as pulmonary edema. Another CXR was taken at 5 am. 

The backache that was started last night also became more severe and intolerable which add more distress. In the afternoon, the shortness of breath was worsening and the blood oxygen saturation was dropping despite on 100% oxygen that was given through mask.  The clinicians including Infectious Disease physician came to review the condition, but they are still not certain about the cause. The differential diagnoses are pulmonary edema, infection or lung injury. Afraid of further deterioration that can occur at any time especially during night, they decided to transfer to ICU for close monitoring and support. While waiting for blood culture result and the possiblity of infection, antibiotic (IV Tienam) was added. The haemoglobin after transfusion is raised to 8.8. 

In ICU, non-invasive ventilation (Bi-PAP) with 50% oxygen was given. The anesthetic registrar on-call came and reviewed. He told that the lung is failed to function normally and need close monitoring because it can be deteriorated at any time. The blood pressure was on low side and ECG showed tachycardia (140 to 150 beat per minute). Toward the midnight, the blood pressure is picked up and blood oxygen level is maintained 99 to 100%.

Bilevel Positive Airway Pressure (Bi-PAP) ventilator and mask