Holy Cow! (“I’m Bloodless”)

A 59-year-old female, a self-described homemaker, and a mother to three children presents to the emergency department (ED) with acute-on-chronic anemia secondary to lower gastrointestinal (GI) bleeding (the patient is known to have a history of colonic diverticular bleeding) and iron deficiency. The patient takes iron and vitamin supplements at home. She additionally takes warfarin due to a history of atrial fibrillation. The patient’s hemoglobin (Hgb) level is 6.4 g/dL in the ED, and the patient appears pale with tachycardia (heart rate 110 beats/min) though her blood pressure is stable at 130/80 mmHg and her oxygen saturation is normal (98%) on room air. A type and screen sample (ethylenediaminetetraacetic acid [EDTA] anticoagulant) is submitted to the blood bank along with a request for crossmatch of two units of red blood cells (RBCs).