Multiple Repetitive blood clot while cross match for Blood T | Figure 1

Multiple Repetitive blood clot while cross match for Blood Transfusion

Our fellow Senior Doctor (55 years-Male) is known diabetic type 2 for more than 20 years. Four months ago he was admitted to Hospital due to septicemia with high sugar trends and paraplegia.

Being treated for the septicemia, his sugar was stabilized for more than 3 weeks before discharge.

At home he developed a huge sacral wound, resulting in readmission to the Hospital where surgical debridement and further investigations were done.

He was then diagnosed with:

• Septicemia due to septic pressure sores
• T2DM with neuropathy
• Potts disease with paraplegia
• S.Malaria with severe anemia
• Pan Gastritis (?? Stress ulcers/DM gastroparesis//Ant TB induced mucosal erosion)

He is on:

• Ceftriaxone 1g bid
• Metronidazole 500mg tds
• Paracetamol IV
• Ant-TB (RHZE)
• Insulin (actrapid & insulatard)
• Amytriplitilin
• Artmether ant malaria
• Pantoprazole

His status:

• Recurrent hypoglycemia trends
• Doesn’t want to eat orally
• Sleepy
• Wound - Very slow progress

G/E

• Pale ++ current HB is 4.1
• Not febrile
• Icteric sclera
• No edema
• With colostomy (for faecal diversion)

RS: Clear lung fields

PA: Normal findings with patent and functional end-loop colostomy

W/site: Clean with some slough info serial bedside debridement.

My Questions

1. Hematology: What can be done regarding sensitize sub groups of his Blood group B RH +Ve so that we can transfuse him safely?
2. Is dexamethasone enough, and how can we monitor the reaction to prevent his kidney and lung from injury (reactions)?

Please advise us.

Asante sana