Not much improvement observed in the early morning. After the ward round, Dr Goh explained that the most likely cause for this condition is called Transfusion Related Acute Lung Injury (TRALI). This a rare condition that can occur after transplantation due to presence of certain antibody in the donor's plasma against the recipient's white cells. The attack that happen yesterday afternoon was the peak and starting to improve and will be recovered within 72 hours. The oxygen given through Bi-PAP is reduced to 40% and they will keep watching for improvement and KIV to discontinue it temporarily in the evening . The CXR was repeated again this morning. He also mentioned that the serum bilirubin and renal creatinine started to increase due to venous occlusion disease (VOD). This condition is a common complication of BMT. She will be given a medication (defibrotide) to reduce the effect of this disease.
Repeat FBC revealed platelet count was only 15,000 and platelet was transfused. During the night time, the menstrual bleeding became more heavy and it was associated with dysmenorrhagia. The FBC after platelet transfusion was increased to 47,000, but Hb was 7. Received another packed-red blood cell. Otherwise, blood pressure and oxygen saturation were maintained.
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