Lymphoma\Brother's Bone Marrow\Bone Marrow Transplant\Death

The patient was a 34-year-old woman diagnosed with T-cell lymphoma. She developed graft-versus-host disease after bone marrow transplantation. The following are excerpts from her inpatient medical records. Doctor's orders, Print time: May 11, 12:52 Bed number/Name/Quantity/Dose/Frequency Ipratropium bromide 2 ml (self-provided) 1.000 tid, taken home Nifedipine sustained-release tablets 30 mg (self-provided) 1.000 qd, taken home Ethambutol inhalation aerosol 10 ml (self-provided) 1.000 q6h, taken home Fingerstick blood glucose monitoring 1.000 qd subcutaneous 0.9% Sodium chloride injection 50 ml/bag 50.000 ml qd 10% Potassium chloride injection 10 ml:1.0 g/ampule 0.9% Sodium chloride injection 500 ml/bag 250.000 ml qd Potassium chloride injection 1.0 g/10 ml/vial 1.500 g Magnesium sulfate injection 10 ml:2.5 g 10.000 ml 0.9% Sodium chloride injection 250 ml/bag 250.000 ml qd Potassium chloride injection 1.0 g/10 ml/vial 0.500 g 20% Medium/long-chain fat emulsion injection 0.4 g:250 ml/bottle (0.200 g qd) 0.9% Sodium chloride injection 250 ml/bag 250.000 ml qd Sodium para-aminosalicylate for injection 2 g/vial 6.000 g Potassium chloride injection 1.0 g/10 ml/vial 0.500 g 5% Glucose injection 250 ml/bag 250.000 ml qd Amphotericin B for injection 25 mg/vial 20.000 mg Sterile water for injection 10 ml 50/ampule 5.000 ml 0.9% Sodium chloride injection 100 ml/bag 100.000 ml qd Omeprazole sodium for injection 20 mg/vial (10.00%) 40.000 mg 5% Glucose injection 100 ml/bag 100.000 ml qd 0.9% Sodium chloride injection 100 ml/bag 100.000 ml qd Dexamethasone sodium phosphate injection 5 mg/1 ml 10/ampule 10.000 mg 10% Fat emulsion, amino acids and glucose injection 1000 ml/bag (1000.000 ml qd) Multivitamins for injection (12) 5 ml/ampule (5.000 ml) Potassium chloride injection 1.0 g/10 ml/vial 3.000 g Regular insulin 10 u 1.000 Itraconazole 200 mg iv gtt qd NS 100 ml Tigecycline 50 mg iv gtt q12h 0.9% Sodium chloride injection 50 ml/bag 20.000 ml q8h Nikethamide injection 0.375 g 1/ampule 5 ml/h 0.375 g

Complete blood count report WBC 7.50 (3.5-9.5 * 10⁹/L) RBC 3.28 (3.8-5.1 * 10¹²/L) HGB 109 (115-150 g/L) HCT 32.10 (35-45%) MCV 97.90 (82-100 fL) MCH 33.20 (27-34 pg) MCHC 340.00 (316-354 g/L) PLT 146.00 (125-350 * 10⁹/L) RDW-SD 48.60 (37-54 fL) RDW-CV 14.30 (11.5-14.5%) NEUT# 7.09 (1.8-6.3 * 10⁹/L) LYMPH# 0.11 (1.1-3.2 * 10⁹/L) MONO# 0.30 (0.1-0.6 * 10⁹/L) EO# 0 (0.02-0.52 * 10⁹/L) BASO# 0 (0-0.06 * 10⁹/L) NEUT% 94.50 (40-75%) LYMPH% 1.50 (20-50%) MONO% 4.00 (3-10%) EO% 0 (0.4-8%) BASO% 0 (0-1%) RET# 44.9 (30-111 * 10⁹/L) RET% 1.37 (0.5-2.5%) LFR 98.7 (85-98%) MFR 1.3 (2-12%) HFR 0 (0-2%) IRF 1.3 (2-14%) Complete blood count report WBC 5.37 (3.5-9.5 * 10⁹/L) RBC 2.79 (3.8-5.1 * 10¹²/L) HGB 93 (115-150 g/L) HCT 26.30 (35-45%) MCV 94.30 (82-100 fL) MCH 33.30 (27-34 pg) MCHC 354.00 (316-354 g/L) PLT 170.00 (125-350 * 10⁹/L) RDW-SD 40.20 (37-54 fL) RDW-CV 12.50 (11.5-14.5%) NEUT# 5.09 (1.8-6.3 * 10⁹/L) LYMPH# 0.13 (1.1-3.2 * 10⁹/L) MONO# 0.15 (0.1-0.6 * 10⁹/L) EO# 0 (0.02-0.52 * 10⁹/L) BASO# 0 (0-0.06 * 10⁹/L) NEUT% 94.80 (40-75%) LYMPH% 2.40 (20-50%) MONO% 2.80 (3-10%) EO% 0 (0.4-8%) BASO% 0 (0-1%) RET# 39.9 (30-111 * 10⁹/L) RET% 1.43 (0.5-2.5%) LFR 94.7 (85-98%) MFR 4.3 (2-12%) HFR 1.0 (0-2%) IRF 5.3 (2-14%) Complete blood count report WBC 7.69 (3.5-9.5 * 10⁹/L) RBC 3.11 (3.8-5.1 * 10¹²/L) HGB 103 (115-150 g/L) HCT 29.60 (35-45%) MCV 95.20 (82-100 fL) MCH 33.10 (27-34 pg) MCHC 348.00 (316-354 g/L) PLT 165.00 (125-350 * 10⁹/L) RDW-SD 41.80 (37-54 fL) RDW-CV 12.70 (11.5-14.5%) NEUT# 7.03 (1.8-6.3 * 10⁹/L) LYMPH# 0.27 (1.1-3.2 * 10⁹/L) MONO# 0.39 (0.1-0.6 * 10⁹/L) EO# 0 (0.02-0.52 * 10⁹/L) BASO# 0 (0-0.06 * 10⁹/L) NEUT% 91.40 (40-75%) LYMPH% 3.50 (20-50%) MONO% 5.10 (3-10%) EO% 0 (0.4-8%) BASO% 0 (0-1%) RET# 56.3 (30-111 * 10⁹/L) RET% 1.81 (0.5-2.5%) LFR 94.5 (85-98%) MFR 5.5 (2-12%) HFR 0 (0-2%) IRF 5.5 (2-14%) Complete blood count report WBC 10.10 (3.5-9.5 * 10⁹/L) RBC 2.86 (3.8-5.1 * 10¹²/L) HGB 96 (115-150 g/L) HCT 26.80 (35-45%) MCV 93.70 (82-100 fL) MCH 33.60 (27-34 pg) MCHC 358.00 (316-354 g/L) PLT 157.00 (125-350 * 10⁹/L) RDW-SD 40.40 (37-54 fL) RDW-CV 12.50 (11.5-14.5%) NEUT# 9.44 (1.8-6.3 * 10⁹/L) LYMPH# 0.32 (1.1-3.2 * 10⁹/L) MONO# 0.34 (0.1-0.6 * 10⁹/L) EO# 0 (0.02-0.52 * 10⁹/L) BASO# 0 (0-0.06 * 10⁹/L) NEUT% 93.40 (40-75%) LYMPH% 3.20 (20-50%) MONO% 3.40 (3-10%) EO% 0 (0.4-8%) BASO% 0 (0-1%) RET# 67.5 (30-111 * 10⁹/L) RET% 2.36 (0.5-2.5%) LFR 96.8 (85-98%) MFR 3.0 (2-12%) HFR 0.2 (0-2%) IRF 3.2 (2-14%) Complete blood count report WBC 9.59 (3.5-9.5 * 10⁹/L) RBC 3.25 (3.8-5.1 * 10¹²/L) HGB 107 (115-150 g/L) HCT 32.00 (35-45%) MCV 98.50 (82-100 fL) MCH 32.90 (27-34 pg) MCHC 334.00 (316-354 g/L) PLT 73.00 (125-350 * 10⁹/L) RDW-SD 52.60 (37-54 fL) RDW-CV 15.50 (11.5-14.5%) NEUT# 8.80 (1.8-6.3 * 10⁹/L) LYMPH# 0.45 (1.1-3.2 * 10⁹/L) MONO# 0.34 (0.1-0.6 * 10⁹/L) EO# 0 (0.02-0.52 * 10⁹/L) BASO# 0 (0-0.06 * 10⁹/L) NEUT% 91.80 (40-75%) LYMPH% 4.70 (20-50%) MONO% 3.50 (3-10%) EO% 0 (0.4-8%) BASO% 0 (0-1%) RET# 46.5 (30-111 * 10⁹/L) RET% 1.43 (0.5-2.5%) LFR 90.8 (85-98%) MFR 8.6 (2-12%) HFR 0.6 (0-2%) IRF 9.2 (2-14%) ******* The patient had previously undergone allogeneic bone marrow transplantation with her brother as the donor. She was discharged once after the transplant but was readmitted due to severe rejection reactions. The patient required continuous oxygen supplementation. She died several days later.