An 80-year-old Caucasian male presented with fever of 3-week duration. Outpatient workup for infectious etiologies was negative and due to persistent fever, he was hospitalized for further evaluation of fever of unknown origin (FUO). Physical examination and laboratory studies remained unremarkable; however a follow-up CT scan of chest, abdomen, and pelvis with contrast done to rule out malignancy as an underlying cause of FUO revealed heterogeneous thyroid gland with surrounding hazy changes suggestive of thyroiditis. Thyroid function tests confirmed the diagnosis of subacute thyroiditis. The patient was started on prednisone with good response in his symptoms and was eventually discharged to home. The importance of our case lies in the fact that diagnosing subacute thyroiditis in the absence of classical symptoms of neck pain can be challenging and a physician should have a very high index of suspicion especially in an elderly patient where FUO can be the sole presentation.
Background: The storage lesion is defined as the set of changes that occur in red blood cells (RBCs) during storage. Studies have shown that a prolonged storage period of RBCs is associated with increased destruction after transfusion. The aim of this study is to determine the impact of the storage lesion on the efficacy of RBC transfusions by comparing the mean rise in the hemoglobin of patients who received new vs old blood.Methods: We did a retrospective chart review of all patients who received a single unit of pure red blood cell (PRBC) transfusion in a three-month period. Patients with hemolytic anemia and active bleeding were excluded. The storage lesion was estimated by calculating the number of days to expiration on the day of transfusion. Median days to expiration was calculated to be 11 days. Patients were divided into two groups based on days to expiration. Group A included patients who received old blood (days to expiration: 0-11) and group B included patients who received new blood (days to expiration: 11-38). The mean rise in hemoglobin between the two groups was compared using the paired t-test.Results: The baseline characteristics of both groups were similar. There was no statistically significant difference in the mean rise in hemoglobin (1.01 vs 1.08- p-value 0.298), hematocrit (3.37 vs 3.61- p-value 0.249), and RBC count (0.42 vs 0.44- p-value 0.097) in the group that received old blood vs new blood, respectively.Conclusion: An RBC transfusion with a shorter storage period does not increase hemoglobin more than RBC with a longer storage period.
DescriptionA 76-year-old woman with no significant medical history was brought to the emergency department with complaints of sudden onset of left-sided weakness and facial drooping 1 hour prior to the arrival. On physical examination, patient had profound left-sided neglect and conjugate deviation of the eyes to the right side. Motor examination showed grade 0 power on left upper and lower extremities, and she had 3+ reflexes on the left and 2+ reflexes on the right. Babinski was positive on the left side. She was sent for a CT scan which showed increased density of M1 segment of middle cerebral artery (MCA) with loss of grey white differentiation of MCA territory (figure 1). Alberta Stroke Programme Early CT Score was 8. Patient's initial National Institutes of Health Stroke Scale score was 17 and was immediately given tissue plasminogen activator (TPA) as the family adamantly refused endovascular procedure; however, her post-TPA score was also 17 as she showed no signs of improvement. She was taken for MRI of brain which showed diffusion restriction of right basal ganglia (figure 2) consistent with acute infarct. T2-weighted imaging along with T2/fluid-attenuated inversion recovery did not show increased signal in the corresponding Figure 1 Non-contrast CT done on presentation to the emergency department shows increased density in the middle cerebral artery (MCA, black arrows) with loss of grey white differentiation of MCA territory (white arrows).
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