CHIEF COMPLAINT: acute onset of SOB following transfusion

PRESENT ILLNESS: 81 Russian speaking F with h/o anemia, Crohn's, PE; admit from
ED with dyspnea following blood transfusion.  Patient with
history of myelodysplasia/multifactorial anemia requiring
transfusions at least once monthly.  Presented to hematology
clinic today for planned transfusion (recent hct 22.3) of 1 unit
PRBCs, given over 2.5 hours.  Per heme notes, patient completed
transfusion, walked to BR and reported dyspnea and palpitations.
 Per daughter she developed symptoms during transfusion, which
was "sped up".  In clinic O2 sat 85% RA increasing to 97% on 3L
by FM.  BP 190/50, HR 100.  Later had episode of diarrhea and
vomiting at clinic.  Given 10 IV lasix x 2 at clinic.  Prior to
clinic visit had been feeling very well, in USOH.  Has VNA and
O2 sats on RA at home range 92-96%.
.
In ED vitals were T99.2, P90, BP 170/72.  O2 sat 80% on RA, then
83% on 4L, then 96% on NRB.  Briefly on CPAP (sats 99%), then
back to NRB, and down to 4L NC with sats 96-98%.  Labs included
Hct 27.3, creat 1.8, BNP 1590, trop 0.05.  Received benadryl,
zofran, nitro paste.  CXR with cardiomegaly without pulm edema.
Satting 97% on 4L but tachypneic, prompting ICU admit.
.
Currently feeling much better in ICU, denies nausea, shortness
of breath, chest pain.

MEDICAL HISTORY: #. Anemia, due to renal failure, anemia of chronic disease, and
myelodysplastic syndrome; previously on epo weekly and requiring
regular transfusions, multiple positive anti-RBC antibodies.
#. Chronic bilat LE edema
#. Crohn's disease
#. breast CA s/p s/p R lumpectomy and XRT 13 yrs ago
#. GERD
#. CAD s/p NSTEMI '[**89**]
#. s/p CCY 10 yrs ago
#. HTN (does not appear to be on home meds)
#. hx of bilateral DVTs and saddle embolus in [**2190**], had been on
warfarin.
#. CRI, baseline cr 1.5-1.8
#. MVA 20 years ago with intracranial bleed

MEDICATION ON ADMISSION: omeprazole 20 mg twice daily
prednisone 17 mg daily (for crohn's)
cipro 250 mg [**Hospital1 **] (for crohn's)
folate 1 mg daily
asacol 1200 mg tid (though daughter states not taking regularly)

ALLERGIES: Belladonna Alkaloids

PHYSICAL EXAM: VS: T102.8, BP 128/51, P88, R48, 96% on 4L
General: Appears comfortable, NAD, resp rate currently 24
HEENT: PERRL, NC/AT, conjunctiva with slight pallor.
Neck: difficult to appreciate JVD
Lungs: bibasilar rales, currently R>L while lying on R side
Cardiac: RRR, S1 S2, [**3-6**] SM best at LSB
Abdomen: soft, denies TTP, reducible ventral hernia, +BS
Extrem: [**3-3**]+ gross bilat edema; however only trace pitting.
Warm, well perfused.

FAMILY HISTORY: N/C

SOCIAL HISTORY: Lives with daughter; husband currently at rehab.  Long smoking
history quit 5 years ago.  No EtOH.  In wheelchair at baseline.
Former physician.
Transfusion related acute lung injury (TRALI),Acute kidney failure with lesion of tubular necrosis,Other vascular complications of medical care, not elsewhere classified,Other pulmonary embolism and infarction,Natural blood and blood products causing adverse effects in therapeutic use,Urinary tract infection, site not specified,Regional enteritis of unspecified site,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Anemia in chronic kidney disease,Myelodysplastic syndrome, unspecified,Epistaxis,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Personal history of venous thrombosis and embolism,Personal history of malignant neoplasm of breast,Long-term (current) use of anticoagulants,Personal history of tobacco use
Transfsn rel ac lung inj,Ac kidny fail, tubr necr,Vasc comp med care NEC,Pulm embol/infarct NEC,Adv eff blood products,Urin tract infection NOS,Regional enteritis NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Anemia in chr kidney dis,Myelodysplastic synd NOS,Epistaxis,Esophageal reflux,Crnry athrscl natve vssl,Old myocardial infarct,Hx-ven thrombosis/embols,Hx of breast malignancy,Long-term use anticoagul,History of tobacco use
Admission Date:  [**2193-5-24**]              Discharge Date:   [**2193-5-31**]

Date of Birth:  [**2112-2-19**]             Sex:   F

Service: MEDICINE

Allergies:
Belladonna Alkaloids

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
acute onset of SOB following transfusion

Major Surgical or Invasive Procedure:
None

History of Present Illness:
81 Russian speaking F with h/o anemia, Crohn's, PE; admit from
ED with dyspnea following blood transfusion.  Patient with
history of myelodysplasia/multifactorial anemia requiring
transfusions at least once monthly.  Presented to hematology
clinic today for planned transfusion (recent hct 22.3) of 1 unit
PRBCs, given over 2.5 hours.  Per heme notes, patient completed
transfusion, walked to BR and reported dyspnea and palpitations.
 Per daughter she developed symptoms during transfusion, which
was "sped up".  In clinic O2 sat 85% RA increasing to 97% on 3L
by FM.  BP 190/50, HR 100.  Later had episode of diarrhea and
vomiting at clinic.  Given 10 IV lasix x 2 at clinic.  Prior to
clinic visit had been feeling very well, in USOH.  Has VNA and
O2 sats on RA at home range 92-96%.
.
In ED vitals were T99.2, P90, BP 170/72.  O2 sat 80% on RA, then
83% on 4L, then 96% on NRB.  Briefly on CPAP (sats 99%), then
back to NRB, and down to 4L NC with sats 96-98%.  Labs included
Hct 27.3, creat 1.8, BNP 1590, trop 0.05.  Received benadryl,
zofran, nitro paste.  CXR with cardiomegaly without pulm edema.
Satting 97% on 4L but tachypneic, prompting ICU admit.
.
Currently feeling much better in ICU, denies nausea, shortness
of breath, chest pain.


Past Medical History:
#. Anemia, due to renal failure, anemia of chronic disease, and
myelodysplastic syndrome; previously on epo weekly and requiring
regular transfusions, multiple positive anti-RBC antibodies.
#. Chronic bilat LE edema
#. Crohn's disease
#. breast CA s/p s/p R lumpectomy and XRT 13 yrs ago
#. GERD
#. CAD s/p NSTEMI '[**89**]
#. s/p CCY 10 yrs ago
#. HTN (does not appear to be on home meds)
#. hx of bilateral DVTs and saddle embolus in [**2190**], had been on
warfarin.
#. CRI, baseline cr 1.5-1.8
#. MVA 20 years ago with intracranial bleed

Social History:
Lives with daughter; husband currently at rehab.  Long smoking
history quit 5 years ago.  No EtOH.  In wheelchair at baseline.
Former physician.

Family History:
N/C

Physical Exam:
VS: T102.8, BP 128/51, P88, R48, 96% on 4L
General: Appears comfortable, NAD, resp rate currently 24
HEENT: PERRL, NC/AT, conjunctiva with slight pallor.
Neck: difficult to appreciate JVD
Lungs: bibasilar rales, currently R>L while lying on R side
Cardiac: RRR, S1 S2, [**3-6**] SM best at LSB
Abdomen: soft, denies TTP, reducible ventral hernia, +BS
Extrem: [**3-3**]+ gross bilat edema; however only trace pitting.
Warm, well perfused.

Pertinent Results:
CXR:
1. The acute onset of alveolar infiltrates, likely edema and the
left lower lobe consolidation with the patient's history of
transfusion suggest a transfusion related acute lung injury.

ECHO:
The left atrium is normal in size. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Left ventricular systolic function is hyperdynamic (EF
70-80%). Tissue Doppler imaging suggests a normal left
ventricular filling pressure (PCWP<12mmHg). There is no
ventricular septal defect. The right ventricular free wall is
hypertrophied. Right ventricular chamber size is normal. with
normal free wall contractility. The ascending aorta is mildly
dilated. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. There is no
mitral valve prolapse. Trivial mitral regurgitation is seen.
There is mild pulmonary artery systolic hypertension. There is
no pericardial effusion.

Brief Hospital Course:
81 F with anemia/myelodysplasia receiving regular transfusions
with known RBC antigen antibodies admitted with dyspnea and
hypoxemia following transfusion.

SOB: It was felt that the patient had a TRALI reaction.  The
blook bank was going to perform further testing on the donor
blood as confirmation.  The patient does have chronic anemia
secondary to a chronic myeloplastic disorder.  She is
transfusion dependent and receives packed red blood cell
transfusions about once per month.  She did have an additional
transfusions (3 units) after admission to the intensive case
unit without further incident.

Also, there was concern about a PE.  A V/Q scan was performed
and showed a moderate to high probablity for a PE.  She was
started on presumptive treatment with lovenox daily.  She will
followup with her PCP to determine the length of treatment.

Fever/Altered mental status:  During her hospital course she was
treated with a 3 day course of bactrim.  Her mental status
improved to baseline with treatment of the UTI.

Crohns: The patients crohns was stable.  She was seen by Dr [**Last Name (STitle) 3708**]
(her Gastroenterolgoist) who said she is overdue for
colonoscopy/EGD but this was to be scheduled as an outpatient.

Of note, the patient remained FULL CODE during her hospital
course.


Medications on Admission:
omeprazole 20 mg twice daily
prednisone 17 mg daily (for crohn's)
cipro 250 mg [**Hospital1 **] (for crohn's)
folate 1 mg daily
asacol 1200 mg tid (though daughter states not taking regularly)

B12 monthly


Discharge Medications:
1. Enoxaparin 60 mg/0.6 mL Syringe Sig: Sixty (60) mg
Subcutaneous Q24H (every 24 hours).
Disp:*1800 mg* Refills:*2*
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Mesalamine 400 mg Tablet, Delayed Release (E.C.) Sig: Three
(3) Tablet, Delayed Release (E.C.) PO TID (3 times a day).
4. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours).
5. Prednisone 5 mg Tablet Sig: Three (3) Tablet PO once a day.
Disp:*90 Tablet(s)* Refills:*2*
6. Prednisone 1 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 1952**], [**Location (un) 86**]

Discharge Diagnosis:
Primary diagnosis:
Likely transfusion reaction

Discharge Condition:
Stable, with Hct of 31


Discharge Instructions:
You were admitted to the hospital with shortness of breath after
a blood transfusion.  You were initially treated in the ICU and
were then transferred to the medicine floor.  We also performed
a V/Q scan which shows that there may be a pulmonary embolism
contributing to your shortness of breath.  You were started on a
blood thinner called lovenox (60mcg per day).  You will need to
continue this for at least 6 months.  Please discuss this with
your primary care doctor.

You received a total of 3 units of blood while you were
hospitalized.  Please continue to have your blood checked and
have transfusions as needed as an outpatient.

Also, you were treated for a urinary tract infection.  You
received 3 days of bactrim.

Please return to the hospital for worsening shortness of breath,
difficulty breathing, chest pain, fevers, or chills.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) 2191**] [**Last Name (NamePattern1) **], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2193-6-7**]
11:00

Please follow up with Dr. [**Last Name (STitle) 3357**] within two weeks after
discharge.  The phone number is [**Telephone/Fax (1) 4606**].
{'Transfusion related acute lung injury (TRALI),Acute kidney failure with lesion of tubular necrosis,Other vascular complications of medical care, not elsewhere classified,Other pulmonary embolism and infarction,Natural blood and blood products causing adverse effects in therapeutic use,Urinary tract infection, site not specified,Regional enteritis of unspecified site,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Anemia in chronic kidney disease,Myelodysplastic syndrome, unspecified,Epistaxis,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Personal history of venous thrombosis and embolism,Personal history of malignant neoplasm of breast,Long-term (current) use of anticoagulants,Personal history of tobacco use'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: acute onset of SOB following transfusion

PRESENT ILLNESS: 81 Russian speaking F with h/o anemia, Crohn's, PE; admit from
ED with dyspnea following blood transfusion.  Patient with
history of myelodysplasia/multifactorial anemia requiring
transfusions at least once monthly.  Presented to hematology
clinic today for planned transfusion (recent hct 22.3) of 1 unit
PRBCs, given over 2.5 hours.  Per heme notes, patient completed
transfusion, walked to BR and reported dyspnea and palpitations.
 Per daughter she developed symptoms during transfusion, which
was "sped up".  In clinic O2 sat 85% RA increasing to 97% on 3L
by FM.  BP 190/50, HR 100.  Later had episode of diarrhea and
vomiting at clinic.  Given 10 IV lasix x 2 at clinic.  Prior to
clinic visit had been feeling very well, in USOH.  Has VNA and
O2 sats on RA at home range 92-96%.
.
In ED vitals were T99.2, P90, BP 170/72.  O2 sat 80% on RA, then
83% on 4L, then 96% on NRB.  Briefly on CPAP (sats 99%), then
back to NRB, and down to 4L NC with sats 96-98%.  Labs included
Hct 27.3, creat 1.8, BNP 1590, trop 0.05.  Received benadryl,
zofran, nitro paste.  CXR with cardiomegaly without pulm edema.
Satting 97% on 4L but tachypneic, prompting ICU admit.
.
Currently feeling much better in ICU, denies nausea, shortness
of breath, chest pain.

MEDICAL HISTORY: #. Anemia, due to renal failure, anemia of chronic disease, and
myelodysplastic syndrome; previously on epo weekly and requiring
regular transfusions, multiple positive anti-RBC antibodies.
#. Chronic bilat LE edema
#. Crohn's disease
#. breast CA s/p s/p R lumpectomy and XRT 13 yrs ago
#. GERD
#. CAD s/p NSTEMI '[**89**]
#. s/p CCY 10 yrs ago
#. HTN (does not appear to be on home meds)
#. hx of bilateral DVTs and saddle embolus in [**2190**], had been on
warfarin.
#. CRI, baseline cr 1.5-1.8
#. MVA 20 years ago with intracranial bleed

MEDICATION ON ADMISSION: omeprazole 20 mg twice daily
prednisone 17 mg daily (for crohn's)
cipro 250 mg [**Hospital1 **] (for crohn's)
folate 1 mg daily
asacol 1200 mg tid (though daughter states not taking regularly)

ALLERGIES: Belladonna Alkaloids

PHYSICAL EXAM: VS: T102.8, BP 128/51, P88, R48, 96% on 4L
General: Appears comfortable, NAD, resp rate currently 24
HEENT: PERRL, NC/AT, conjunctiva with slight pallor.
Neck: difficult to appreciate JVD
Lungs: bibasilar rales, currently R>L while lying on R side
Cardiac: RRR, S1 S2, [**3-6**] SM best at LSB
Abdomen: soft, denies TTP, reducible ventral hernia, +BS
Extrem: [**3-3**]+ gross bilat edema; however only trace pitting.
Warm, well perfused.

FAMILY HISTORY: N/C

SOCIAL HISTORY: Lives with daughter; husband currently at rehab.  Long smoking
history quit 5 years ago.  No EtOH.  In wheelchair at baseline.
Former physician. 

### Response:
{'Transfusion related acute lung injury (TRALI),Acute kidney failure with lesion of tubular necrosis,Other vascular complications of medical care, not elsewhere classified,Other pulmonary embolism and infarction,Natural blood and blood products causing adverse effects in therapeutic use,Urinary tract infection, site not specified,Regional enteritis of unspecified site,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Anemia in chronic kidney disease,Myelodysplastic syndrome, unspecified,Epistaxis,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Personal history of venous thrombosis and embolism,Personal history of malignant neoplasm of breast,Long-term (current) use of anticoagulants,Personal history of tobacco use'}
