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Postgraduate Education Center: PULMONARY AND CRITICAL CARE PEARLS |

An 87-Year-Old Woman With Respiratory Distress and Alveolar Hemorrhage After Transfusion*

Kamran Darabi, MD; Omar Abdel-Wahab, MD; Christopher Stowell, MD, PhD; Alireza Sepehr, MD
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*From the Departments of Pathology (Drs. Stowell and Sepehr) and Medicine (Dr. Abdel-Wahab), Massachusetts General Hospital, Boston, MA; and Division of Hematology and Medical Oncology (Dr. Darabi), Our Lady of Mercy Medical Center, Bronx, NY.

Correspondence to: Kamran Darabi, MD, Our Lady of Mercy Medical Center, Cancer Center, 600 East 233rd St, Bronx, NY 10466; e-mail: kamrandarabi@yahoo.com



Chest. 2006;130(5):1612-1616. doi:10.1378/chest.130.5.1612
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An 87-year-old woman was taken to the emergency department of a nearby hospital for evaluation of confusion. The patient’s medical history was notable for hypertension, hyperlipidemia, COPD, and coronary artery bypass grafting. Echocardiography performed 2 weeks prior to hospital admission revealed an estimated ejection fraction of 59%, right ventricular dilation, diastolic and systolic interventricular septal flattening, stable severe tricuspid regurgitation, and no obvious ventricular wall motion abnormalities. In addition to coronary artery disease, the patient had a history of sick sinus syndrome for which a dual-chamber pacemaker had been placed 4 months prior. She was maintained on anticoagulation with warfarin, 3 mg/d, but had variable international normalized ratio values ranging from 1.0 to 3.3. The patient was a former smoker, and recent pulmonary function tests demonstrated FEV1 of 52% of predicted; FVC, 61% of predicted; FEV1/FVC ratio, 86% of predicted; total lung capacity, 113% of predicted; and residual volume, 180% of predicted.

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