Acute PV Bleed

A patient presented with a two-week history of substantial PV bleeding. She was admitted into the Medical Centre and placed on bed rest, oxygen and IV rehydration. A full blood count revealed a HB of 7g/dl. Her blood pressure gradually dropped and she became syncopal on sitting. Her FBC was analysed regulary and noted to be dropped 0.5g/dl every two hours. We still had 18 hours to go until arrival in Southampton so we had to consider the available options.

The patient (a nurse herself) was initially against transfusion and we were unsure about the risks as she was a renal transplant patient because of polycystic kidneys and was on immunosuppressive treatment. Diversion was not a realistic proposition given the roughness of the sea and our geographic position.

The case was discussed via satellite telephone with the duty renal registrar at Manchester Royal Infirmary where the patient had previously been treated. The registrar assured us that transfusion was not a problem.

The protocols for blood transfusion as outlined in the company's Fleet Medical Regulations were reviewed and followed. We put out a broadcast for established blood donors with donor cards and confirmed both the donor's and the patient's blood group with Eldoncards. Screening was conducted for infectious diseases such as HIV and Hepatitis B. Two units of blood initially were harvested. One unit was transfused over two hours and the second over four. Meticulous observations were made for transfusion reactions. The PV bleeding continued but eased and her general condition improved overnight. She was safely transferred by ambulance to Princess Anne Hospital Southampton for further management when the ship docked the next day.