SHM Converge Scientific Abstract ePoster Gallery-Emergence of Posterior Reversible Encephalopathy Syndrome After Blood Transfusion

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This case report describes posterior reversible encephalopathy syndrome (PRES) occurring after blood transfusion, a rare complication that clinicians should recognize in patients with chronic anemia. PRES is a clinico-radiological syndrome commonly associated with severe hypertension, eclampsia, renal failure, autoimmune disease, toxins, and certain medications. Typical symptoms include headache, altered mental status, seizures, and visual changes.<br /><br />The patient was a 52-year-old woman who presented with confusion, headache, and bilateral vision loss. One month earlier, she had been hospitalized for profound anemia caused by chronic menorrhagia, with a hemoglobin of 1.6 g/dL, and had received multiple blood transfusions. On arrival, her blood pressure was normal, but she was only oriented to person and place and had left gaze deviation and complete bilateral visual loss. Initial CT of the head was negative for hemorrhage or ischemia. MRI later showed posterior reversible encephalopathy syndrome with small acute ischemic infarcts in the left frontal and bilateral parietal lobes.<br /><br />She was treated supportively, including with antiepileptic medication, and improved clinically. At discharge, she still had some residual neurological deficits, including dysarthria, right dysmetria, and left sixth cranial nerve weakness.<br /><br />The proposed mechanism for transfusion-related PRES is that chronic anemia may cause baseline cerebral vasodilation; transfusion then increases blood viscosity and flow, triggering cerebral vasoconstriction and endothelial dysfunction. The presentation highlights the need for vigilance for neurological symptoms after transfusion in severely anemic patients. Diagnosis relies on MRI when compatible symptoms are present, and management focuses on seizure control, correcting triggers, and supportive care.

Asset Subtitle

Shristi Nepal

Meta Tag

Author List Dwayne Gordon, Shammas Bajwa, Shristi Nepal

Category Clinical Vignettes

Concept Posterior Reversible Encephalopathy Syndrome

Concept Blood Transfusion

Concept Clinico-radiological Diagnosis

Concept Chronic Severe Anemia

Concept Magnetic Resonance Imaging

Distinguished Non-Finalist

Presenter Organization Hartford Hospital

Presenting Author Shristi Nepal

Track Adult

Keywords

posterior reversible encephalopathy syndrome

PRES

blood transfusion

chronic anemia

menorrhagia

visual loss

seizures

MRI

endothelial dysfunction

neurological deficits

Posterior Reversible Encephalopathy Syndrome

Blood Transfusion

Clinico-radiological Diagnosis

Chronic Severe Anemia

Magnetic Resonance Imaging