Costly Errors

Stage A 74-year-old woman was referred to a hematologist for a transfusion-dependent anemia that had been present for seven months. The anemia was initially recognized after a fall that caused fractures of several ribs and a lumbar vertebra. Prednisone (40 mg twice daily) had been administered after the report of a positive Coombs' test, but it had not corrected the anemia. The patient required two to three units of blood each week to maintain her hematocrit between 20 and 25 percent. Response This is a patient with a severe Coombs'-positive anemia that has proved refractory to high doses of prednisone. . . .