CHIEF COMPLAINT: Hypotension during platelet transfusion

PRESENT ILLNESS: Mrs. [**Known lastname 3273**] is a 75 year old woman with amyloidosis (dx in
[**2149**]) w/ restrictive cardiomyopathy on Revlimid and decadron,
thrombocytopenia (suspected ITP), who was admitted for fevers
and hypotension during a platelet transfusion.
.
Recent hisory, adapted from OMR:  On day 17 of her 3rd cycle of
Revlimid and Decadron, she presented to clinic for routine
follow-up and was noted to have a dramatic drop in her platelet
count from 173K to 5K over a two week period. She was admitted
for a likely diagnosis of ITP and was initiated on a course of
Decadron. She was discharged home the following day and on
repeat count check on [**2151-11-5**] her platelet count was improved
at 36K. She continued on a Decadron taper and upon her visit on
[**2151-11-11**] her platelet count had dropped to 20K. The decision was
made to start her on 4 weekly doses of Rituxan, which she
received on [**2151-11-12**]. She was also switched to a prednisone
taper at an initial dose of 60 mg po daily. On [**2151-11-16**] her
platelets had dropped even more to 14K. Prednisone was stopped
and she was started back on a Decadron course of 40 mg po x 8
days, which she completed on [**2151-11-23**]. She received her 2nd and
3rd doses of weekly Rituxan on [**11-18**] and [**11-25**], which she
tolerated well without any infusion reactions.  She was seen in
clinic on [**2151-11-25**] and was noted to have a platelet count of 9k.
About 10m into a unit of platelets, she developed a temp to
100.3 and was hypotensive to 87/49.  She received fluids and the
transfusion was stopped, however her pressures remained low.
Cultures were drawn and her fever responded to tylenol.
.
In the [**Hospital Unit Name 153**], she was stabilized with fluid, 1u of platelets, and
was given cefepime. She did not have any fevers.
.
Currently, she is feeling well. She has no complaints.  She
denies any obvious signs of bleeding including epistaxis,
gingival bleeding, hematuria, melena, or BRBPR.  She does note
periorbital and perioral bruising.  She denies fevers/chills,
syncope, pre-syncope, abdominal pain, shortness of breath and
chest pain.  She has not had any increase in ostomy output, and
had been started on fluconazole recently for thrush.  She does
note that during the event of hypotension/fever, she felt a
"vacant" feeling.  She states this resolved with tylenol and
fluids.  She has not had this sensation while admitted.

MEDICAL HISTORY: # PAST ONCOLOGIC HISTORY: She initially presented in the fall of
[**2149**] with four to five months of easy bruising and mild dyspnea
on exertion. In [**Month (only) **], she was diagnosed with amyloidosis by
bone marrow biopsy and an abnormal UPEP and was subsequently
started on treatment with Velcade, melphalan, and Decadron. She
completed six cycles of this with a plateau in her response. She
then started on subcutaneous Velcade due to her neuropathy and
GI intolerance. Shortly after she received this treatment, she
was admitted for hemianopsia and found to have a TIA, from which
she recovered without any sequelae. Further treatments with
Velcade was deferred given her TIA, but she was noted to have a
rise in her light chains and well as worsening kidney function
and hypercalcemia concerning for progression of her amyloidosis.
She was therefore started on Revlimid 15 mg daily for 21 day
cycle with aspirin for DVT prophylaxis in addition to 20 mg po
Decadron weekly.  In summary of recent events:
-[**11-12**]: D1 weekly rituxan for ITP, also steroids increased to
decadron 40 mg daily x8 from [**Date range (1) 92781**]
-[**11-25**]: D15 rituxan and platelets
-[**11-26**]: 10 minutes into platelet transfusion BP 87/49, temp
100.3.Given dex 40.
.
# PAST MEDICAL HISTORY:
-Amyloidosis with progressive restrictive amyloid cardiomyopathy

MEDICATION ON ADMISSION: -ACYCLOVIR - 400 mg Tablet - 1 Tablet(s) by mouth twice a day
-DEXAMETHASONE -  4 mg Tablet - 10 Tablet(s) by mouth once a day
(total dose 40 mg) for 8 days, last dose [**2151-11-23**].
-FLUCONAZOLE - 200 mg Tablet - 1 (One) Tablet(s) by mouth once a
day for 7 days (started on [**2151-11-25**])
-FUROSEMIDE - 20 mg Tablet - by mouth daily
-LENALIDOMIDE [REVLIMID] -On Hold from [**2151-11-1**] to unknown for
low platelets) - 15 mg Capsule - 1 (One) Capsule(s) by mouth
once a day x 21 days.
-LEVOTHYROXINE [LEVOXYL] - 75 mcg Tablet - one Tablet(s) by
mouth
once a day - No Substitution
-LORAZEPAM - 0.5 mg Tablet - [**11-22**] Tablet(s) by mouth every 8 hrs
as
needed for nausea, sleep, anxiety
-METOPROLOL TARTRATE - 25 mg Tablet - 1.5 Tablet(s) by mouth
twice
a day
-PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1
Tablet(s)
by mouth daily
-SIMVASTATIN - 10 mg Tablet - 0.5 (One half) Tablet(s) by mouth
daily
-ASPIRIN 81 mg - On Hold from [**2151-11-1**] to unknown for low
platelets) -
-CHOLECALCIFEROL (VITAMIN D3) -  (OTC) - 1,000 unit Capsule - 1
(One) Capsule(s) by mouth once a day

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission to the [**Hospital Unit Name 153**]:
GENERAL: A well-appearing 75-year-old female in no acute
distress, alert and oriented x3.
HEENT: Anicteric sclerae. Extraocular movements are intact. Oral

FAMILY HISTORY: Son: had thyroid cancer
mother: HTN, DM, CVA and died at the age of 63
Father: had prostate cancer with metastasis to the bone

SOCIAL HISTORY: -Very independent woman who currently lives with her husband.
She has 2 grown children.
-Denies tob, etoh
Hypotension, unspecified,Amyloidosis, unspecified,Immune thrombocytopenic purpura,Nutritional and metabolic cardiomyopathy,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Fever, unspecified
Hypotension NOS,Amyloidosis NOS,Immune thrombocyt purpra,Metabolic cardiomyopathy,Abn react-procedure NEC,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Fever NOS
Admission Date:  [**2151-11-26**]              Discharge Date:   [**2151-11-29**]

Date of Birth:  [**2076-2-22**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3918**]
Chief Complaint:
Hypotension during platelet transfusion


Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mrs. [**Known lastname 3273**] is a 75 year old woman with amyloidosis (dx in
[**2149**]) w/ restrictive cardiomyopathy on Revlimid and decadron,
thrombocytopenia (suspected ITP), who was admitted for fevers
and hypotension during a platelet transfusion.
.
Recent hisory, adapted from OMR:  On day 17 of her 3rd cycle of
Revlimid and Decadron, she presented to clinic for routine
follow-up and was noted to have a dramatic drop in her platelet
count from 173K to 5K over a two week period. She was admitted
for a likely diagnosis of ITP and was initiated on a course of
Decadron. She was discharged home the following day and on
repeat count check on [**2151-11-5**] her platelet count was improved
at 36K. She continued on a Decadron taper and upon her visit on
[**2151-11-11**] her platelet count had dropped to 20K. The decision was
made to start her on 4 weekly doses of Rituxan, which she
received on [**2151-11-12**]. She was also switched to a prednisone
taper at an initial dose of 60 mg po daily. On [**2151-11-16**] her
platelets had dropped even more to 14K. Prednisone was stopped
and she was started back on a Decadron course of 40 mg po x 8
days, which she completed on [**2151-11-23**]. She received her 2nd and
3rd doses of weekly Rituxan on [**11-18**] and [**11-25**], which she
tolerated well without any infusion reactions.  She was seen in
clinic on [**2151-11-25**] and was noted to have a platelet count of 9k.
About 10m into a unit of platelets, she developed a temp to
100.3 and was hypotensive to 87/49.  She received fluids and the
transfusion was stopped, however her pressures remained low.
Cultures were drawn and her fever responded to tylenol.
.
In the [**Hospital Unit Name 153**], she was stabilized with fluid, 1u of platelets, and
was given cefepime. She did not have any fevers.
.
Currently, she is feeling well. She has no complaints.  She
denies any obvious signs of bleeding including epistaxis,
gingival bleeding, hematuria, melena, or BRBPR.  She does note
periorbital and perioral bruising.  She denies fevers/chills,
syncope, pre-syncope, abdominal pain, shortness of breath and
chest pain.  She has not had any increase in ostomy output, and
had been started on fluconazole recently for thrush.  She does
note that during the event of hypotension/fever, she felt a
"vacant" feeling.  She states this resolved with tylenol and
fluids.  She has not had this sensation while admitted.

Past Medical History:
# PAST ONCOLOGIC HISTORY: She initially presented in the fall of
[**2149**] with four to five months of easy bruising and mild dyspnea
on exertion. In [**Month (only) **], she was diagnosed with amyloidosis by
bone marrow biopsy and an abnormal UPEP and was subsequently
started on treatment with Velcade, melphalan, and Decadron. She
completed six cycles of this with a plateau in her response. She
then started on subcutaneous Velcade due to her neuropathy and
GI intolerance. Shortly after she received this treatment, she
was admitted for hemianopsia and found to have a TIA, from which
she recovered without any sequelae. Further treatments with
Velcade was deferred given her TIA, but she was noted to have a
rise in her light chains and well as worsening kidney function
and hypercalcemia concerning for progression of her amyloidosis.
She was therefore started on Revlimid 15 mg daily for 21 day
cycle with aspirin for DVT prophylaxis in addition to 20 mg po
Decadron weekly.  In summary of recent events:
-[**11-12**]: D1 weekly rituxan for ITP, also steroids increased to
decadron 40 mg daily x8 from [**Date range (1) 92781**]
-[**11-25**]: D15 rituxan and platelets
-[**11-26**]: 10 minutes into platelet transfusion BP 87/49, temp
100.3.Given dex 40.
.
# PAST MEDICAL HISTORY:
-Amyloidosis with progressive restrictive amyloid cardiomyopathy

-TIA (suspected secondary to Velcade)
-Ulcerative colitis followed by total colectomy and ileostomy
since [**2108**]
-Dyslipidemia
-Cholecystectomy
-Left knee surgery
-Urinary incontinence
-Hypothyroidism

Social History:
-Very independent woman who currently lives with her husband.
She has 2 grown children.
-Denies tob, etoh

Family History:
Son: had thyroid cancer
mother: HTN, DM, CVA and died at the age of 63
Father: had prostate cancer with metastasis to the bone

Physical Exam:
On admission to the [**Hospital Unit Name 153**]:
GENERAL: A well-appearing 75-year-old female in no acute
distress, alert and oriented x3.
HEENT: Anicteric sclerae. Extraocular movements are intact. Oral

mucosa is moist, areas of echymosis, small white plaque on the
back of [**Last Name (un) 46081**] mucosa. No ulcerative lesions, no gingival
bleeding or thrush noted.
NECK: Supple without adenopathy or thyromegaly. No JVD elevation
(~ 9 cm)
LUNGS: Clear to auscultation bilaterally without rhonchi, rales,
or wheezes. Normal respiratory effort.
HEART: RRR, + SEM [**12-27**] on LUSB. No murmurs, rubs, or gallops.
ABDOMEN: Soft, nontender, and nondistended with normoactive
bowel sounds throughout. Ostomy bag is in place (unable to see
color of stool). Dressing is clean, dry, and intact.
EXTREMITIES: Without edema and warm and well perfused. Pulses 2+

throughout
SKIN: Scattered petichiae on ankle area, and multiple echymotic
areas on her face (over right eye) on arms and legs.  No rashes.

NEURO: CN II-XII grossly intact. Strength 5/5. Sensation grossly

intact. Fluent speech, good recall memory.
.
On discharge from the Floor:
Vitals: 110/60; HR 68; T95.4; 100%RA
GENERAL: Well appearing other than periobital and perioral
bruising and purpura.  No acute distress.
HEENT: MMM, mild evidence of thrush
NECK: Supple without adenopathy or thyromegaly
LUNGS: Clear to auscultation bilaterally without rhonchi, rales,
or wheezes. Normal respiratory effort.
HEART: Tachycardic with soft systolic flow murmur
ABDOMEN: Soft, nontender, Ostomy bag is in place. Dressing is
clean, dry, and intact.
EXTREMITIES: Without edema and warm and well perfused. Pulses 2+

throughout
SKIN:  Multiple areas of purpura and ecchymoses scattered over
her body.
NEURO: Gait steady.  CN II-XII intact b/l.  str [**3-25**] b/l.  No
visual field deficits.  No focal deficits appreciated

Pertinent Results:
LABS:
.
On admission:
[**2151-11-26**] 10:21PM BLOOD WBC-3.2* RBC-3.95* Hgb-12.5 Hct-36.6
MCV-93 MCH-31.7 MCHC-34.2 RDW-18.4* Plt Ct-16*
[**2151-11-26**] 10:21PM BLOOD Neuts-92.0* Lymphs-5.1* Monos-2.3 Eos-0.3
Baso-0.2
[**2151-11-26**] 10:21PM BLOOD PT-13.3* PTT-24.3* INR(PT)-1.2*
[**2151-11-26**] 10:21PM BLOOD Glucose-175* UreaN-22* Creat-0.9 Na-143
K-3.7 Cl-111* HCO3-26 AnGap-10
[**2151-11-26**] 10:21PM BLOOD Albumin-2.9* Calcium-7.6* Phos-2.7 Mg-2.0
.
On discharge:
[**2151-11-29**] 07:50AM BLOOD WBC-5.5 RBC-3.79* Hgb-12.0 Hct-35.8*
MCV-95 MCH-31.7 MCHC-33.5 RDW-18.4* Plt Ct-24*
[**2151-11-26**] 10:21PM BLOOD Neuts-92.0* Lymphs-5.1* Monos-2.3 Eos-0.3
Baso-0.2
[**2151-11-29**] 07:50AM BLOOD PT-10.1 PTT-20.6* INR(PT)-0.9
[**2151-11-29**] 07:50AM BLOOD Glucose-102* UreaN-25* Creat-0.7 Na-139
K-3.9 Cl-106 HCO3-26 AnGap-11
[**2151-11-29**] 07:50AM BLOOD Calcium-8.6 Phos-2.2* Mg-2.2
[**2151-11-28**] 07:05AM BLOOD ALT-32 AST-17 LD(LDH)-273* AlkPhos-45
TotBili-0.5
[**2151-11-27**] 08:37AM BLOOD Cortsol-3.8
.
MICRO:
[**11-26**]: Multiple blood cultures: No growth at discharge
..
cxray: FINDINGS: Frontal and lateral views of the chest are
obtained. No focal consolidation, pleural effusion, or
pneumothorax is seen. Cardiac and mediastinal silhouettes are
unremarkable. No overt pulmonary edema is seen.
IMPRESSION: No acute cardiopulmonary process.
.
CT Chest/Abd/Pelvis [**2151-11-28**]:
1. Decreased interval size of mediastinal lymph nodes since
[**2151-9-28**]. No pathologically enlarged lymph nodes in the chest,
abdomen or pelvis.
2. Normal-sized spleen.
3. 7mm ground glass nodule in the right lower lobe, which is
likely infectious or inflammatory. The diffuse centrilobular
nodular opacities seen on [**2151-9-28**] have largely resolved. If
clinically indicated, follow up CT could be performed in one
year to evaluate for stability of the RLL nodule.
4. Bilateral thyroid nodules, the largest on the left, which has
been previously evaluated by ultrasound [**2150-9-15**].


Brief Hospital Course:
Summary:  75-year-old woman with amyloidosis complicated by
restrictive cardiomyopathy and thrombocytopenia attributed to
ITP who as admitted for hypotension and a low grade fever 10
minutes into a platelet transfusion requiring initial admission
to the [**Hospital Unit Name 153**].
.
# Hypotension:  Unclear etiology.  Transfusion reaction vs
adrenal insufficiency vs infection (cultures were negative) vs
tachycardia induced LVOT obstruction vs combination of the
above.  She was initially stabilized in the ICU, and quickly
transferred to the floor.  Cultures were negative.  Blood bank
is working up possible transfusion reaction.  Her metoprolol was
restarted at a lower dose and her lasix was held, and these meds
will need titration as an outpatient.  A prednisone taper was
started out of concern for possible adrenal insufficiency, and
she will need a taper as an outpatient - follow-up scheduled 3
days after discharge.  ***BCx were pending at discharge and will
need follow-up***
.
# Thrombocytopenia: Has been attributed to ITP, given her
frequent drops after transfusions.  CT torso done this admission
was without evidence of malignant process.  Will defer to
outpatient oncologist/hematologist whether to perform a bone
marrow biopsy and/or IVIG for further w/u and management.
.
# AMYLOID CARDIOMYOPATHY: pt has progressive amyloid
cardiomyopathy with a shrinking left ventricle, increasing LV
wall thicknesses, a preserved LVEF, and NYHA class III heart
failure symptoms.  WIll need further outpatient titration of her
metoprolol and lasix (changed this admission secondary to
hypotension).
.
--------
Chronic Issues:
--------
# TIA: patient has h/o TIA while receiving velcade.  Continuing
to hold ASA given her thrombocytopenia
.
# ULCERATIVE COLITIS: pt had total colectomy and ileostomy in
[**2108**].  Output was been stable and unchanged this admission
.
# HYPERLIPIDEMIA: Statin restarted at discharge (held this
admission)
.
# HYPOTHYROIDISM: Continued levothyroxine 75 mcg daily.
.
# Supplements:  Vitamin D
.
# Prophylaxis:  Given her thrombocytopenia, SQH was held, and
ambulation was encouraged.
.
============
TRANSITIONAL ISSUES:
-Metoprolol decreased (titrate as outpatient)
-Lasix held (restart as outpatient - held for hypotension this
adm)
-PPI and ASA continue to be held (thrombocytopenia)
-Will need prednisone taper (40mg daily started [**11-28**])
-RLL nodule --> seen on CT --> f/u imaging in 1 year, if
indicated at that time.
-Blood cultures pending, will need follow-up as outpatient.


Medications on Admission:
-ACYCLOVIR - 400 mg Tablet - 1 Tablet(s) by mouth twice a day
-DEXAMETHASONE -  4 mg Tablet - 10 Tablet(s) by mouth once a day
(total dose 40 mg) for 8 days, last dose [**2151-11-23**].
-FLUCONAZOLE - 200 mg Tablet - 1 (One) Tablet(s) by mouth once a
day for 7 days (started on [**2151-11-25**])
-FUROSEMIDE - 20 mg Tablet - by mouth daily
-LENALIDOMIDE [REVLIMID] -On Hold from [**2151-11-1**] to unknown for
low platelets) - 15 mg Capsule - 1 (One) Capsule(s) by mouth
once a day x 21 days.
-LEVOTHYROXINE [LEVOXYL] - 75 mcg Tablet - one Tablet(s) by
mouth
once a day - No Substitution
-LORAZEPAM - 0.5 mg Tablet - [**11-22**] Tablet(s) by mouth every 8 hrs
as
needed for nausea, sleep, anxiety
-METOPROLOL TARTRATE - 25 mg Tablet - 1.5 Tablet(s) by mouth
twice
a day
-PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1
Tablet(s)
by mouth daily
-SIMVASTATIN - 10 mg Tablet - 0.5 (One half) Tablet(s) by mouth
daily
-ASPIRIN 81 mg - On Hold from [**2151-11-1**] to unknown for low
platelets) -
-CHOLECALCIFEROL (VITAMIN D3) -  (OTC) - 1,000 unit Capsule - 1
(One) Capsule(s) by mouth once a day


Discharge Medications:
1. acyclovir 400 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
2. fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
3. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO every eight (8)
hours as needed for nausea, insomnia, anxiety.
5. cholecalciferol (vitamin D3) 1,000 unit Capsule Sig: One (1)
Capsule PO once a day.
6. simvastatin 5 mg Tablet Sig: One (1) Tablet PO once a day.
7. prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily)
for 5 days: Until instructed to change dosing by your outpatient
doctors.
[**Last Name (Titles) **]:*qs Tablet(s)* Refills:*0*
8. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).


Discharge Disposition:
Home

Discharge Diagnosis:
Amyloidosis
thrombocytopenia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted for low blood pressure and an elevated
temperature after getting a platelet transfusion.  Your blood
pressure has improved while in the hospital, and you did not
have any more fevers.  You should make sure to follow up with
your doctors as listed below.
.
Please also note the following medication changes:
-Please START prednisone 40mg daily, and discuss the need for
this medication at your next follow-up appointment.  You should
NOT take revlimid or dexamethasone until instructed by your
outpatient doctors.
.
-Please DECREASE your metoprolol tartrate dose to 25mg twice
daily until you see your primary care doctor.
.
-Please STOP taking lasix (furosemide) until you see your
doctors in follow-up
.
-Please continue to NOT take aspirin or pantoprazole (because of
your low platelets) until told to restart these medications by
your doctors

Followup Instructions:
**Please make a follow-up appointment with your primary care
doctor within one week of being discharged from the hospital**
.
Department: BMT/ONCOLOGY UNIT
When: THURSDAY [**2151-12-2**] at 12:00 PM [**Telephone/Fax (1) 447**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: Main Garage


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 3922**]

Completed by:[**2151-11-30**]
{'Hypotension, unspecified,Amyloidosis, unspecified,Immune thrombocytopenic purpura,Nutritional and metabolic cardiomyopathy,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Fever, unspecified'}


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: Hypotension during platelet transfusion

PRESENT ILLNESS: Mrs. [**Known lastname 3273**] is a 75 year old woman with amyloidosis (dx in
[**2149**]) w/ restrictive cardiomyopathy on Revlimid and decadron,
thrombocytopenia (suspected ITP), who was admitted for fevers
and hypotension during a platelet transfusion.
.
Recent hisory, adapted from OMR:  On day 17 of her 3rd cycle of
Revlimid and Decadron, she presented to clinic for routine
follow-up and was noted to have a dramatic drop in her platelet
count from 173K to 5K over a two week period. She was admitted
for a likely diagnosis of ITP and was initiated on a course of
Decadron. She was discharged home the following day and on
repeat count check on [**2151-11-5**] her platelet count was improved
at 36K. She continued on a Decadron taper and upon her visit on
[**2151-11-11**] her platelet count had dropped to 20K. The decision was
made to start her on 4 weekly doses of Rituxan, which she
received on [**2151-11-12**]. She was also switched to a prednisone
taper at an initial dose of 60 mg po daily. On [**2151-11-16**] her
platelets had dropped even more to 14K. Prednisone was stopped
and she was started back on a Decadron course of 40 mg po x 8
days, which she completed on [**2151-11-23**]. She received her 2nd and
3rd doses of weekly Rituxan on [**11-18**] and [**11-25**], which she
tolerated well without any infusion reactions.  She was seen in
clinic on [**2151-11-25**] and was noted to have a platelet count of 9k.
About 10m into a unit of platelets, she developed a temp to
100.3 and was hypotensive to 87/49.  She received fluids and the
transfusion was stopped, however her pressures remained low.
Cultures were drawn and her fever responded to tylenol.
.
In the [**Hospital Unit Name 153**], she was stabilized with fluid, 1u of platelets, and
was given cefepime. She did not have any fevers.
.
Currently, she is feeling well. She has no complaints.  She
denies any obvious signs of bleeding including epistaxis,
gingival bleeding, hematuria, melena, or BRBPR.  She does note
periorbital and perioral bruising.  She denies fevers/chills,
syncope, pre-syncope, abdominal pain, shortness of breath and
chest pain.  She has not had any increase in ostomy output, and
had been started on fluconazole recently for thrush.  She does
note that during the event of hypotension/fever, she felt a
"vacant" feeling.  She states this resolved with tylenol and
fluids.  She has not had this sensation while admitted.

MEDICAL HISTORY: # PAST ONCOLOGIC HISTORY: She initially presented in the fall of
[**2149**] with four to five months of easy bruising and mild dyspnea
on exertion. In [**Month (only) **], she was diagnosed with amyloidosis by
bone marrow biopsy and an abnormal UPEP and was subsequently
started on treatment with Velcade, melphalan, and Decadron. She
completed six cycles of this with a plateau in her response. She
then started on subcutaneous Velcade due to her neuropathy and
GI intolerance. Shortly after she received this treatment, she
was admitted for hemianopsia and found to have a TIA, from which
she recovered without any sequelae. Further treatments with
Velcade was deferred given her TIA, but she was noted to have a
rise in her light chains and well as worsening kidney function
and hypercalcemia concerning for progression of her amyloidosis.
She was therefore started on Revlimid 15 mg daily for 21 day
cycle with aspirin for DVT prophylaxis in addition to 20 mg po
Decadron weekly.  In summary of recent events:
-[**11-12**]: D1 weekly rituxan for ITP, also steroids increased to
decadron 40 mg daily x8 from [**Date range (1) 92781**]
-[**11-25**]: D15 rituxan and platelets
-[**11-26**]: 10 minutes into platelet transfusion BP 87/49, temp
100.3.Given dex 40.
.
# PAST MEDICAL HISTORY:
-Amyloidosis with progressive restrictive amyloid cardiomyopathy

MEDICATION ON ADMISSION: -ACYCLOVIR - 400 mg Tablet - 1 Tablet(s) by mouth twice a day
-DEXAMETHASONE -  4 mg Tablet - 10 Tablet(s) by mouth once a day
(total dose 40 mg) for 8 days, last dose [**2151-11-23**].
-FLUCONAZOLE - 200 mg Tablet - 1 (One) Tablet(s) by mouth once a
day for 7 days (started on [**2151-11-25**])
-FUROSEMIDE - 20 mg Tablet - by mouth daily
-LENALIDOMIDE [REVLIMID] -On Hold from [**2151-11-1**] to unknown for
low platelets) - 15 mg Capsule - 1 (One) Capsule(s) by mouth
once a day x 21 days.
-LEVOTHYROXINE [LEVOXYL] - 75 mcg Tablet - one Tablet(s) by
mouth
once a day - No Substitution
-LORAZEPAM - 0.5 mg Tablet - [**11-22**] Tablet(s) by mouth every 8 hrs
as
needed for nausea, sleep, anxiety
-METOPROLOL TARTRATE - 25 mg Tablet - 1.5 Tablet(s) by mouth
twice
a day
-PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1
Tablet(s)
by mouth daily
-SIMVASTATIN - 10 mg Tablet - 0.5 (One half) Tablet(s) by mouth
daily
-ASPIRIN 81 mg - On Hold from [**2151-11-1**] to unknown for low
platelets) -
-CHOLECALCIFEROL (VITAMIN D3) -  (OTC) - 1,000 unit Capsule - 1
(One) Capsule(s) by mouth once a day

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission to the [**Hospital Unit Name 153**]:
GENERAL: A well-appearing 75-year-old female in no acute
distress, alert and oriented x3.
HEENT: Anicteric sclerae. Extraocular movements are intact. Oral

FAMILY HISTORY: Son: had thyroid cancer
mother: HTN, DM, CVA and died at the age of 63
Father: had prostate cancer with metastasis to the bone

SOCIAL HISTORY: -Very independent woman who currently lives with her husband.
She has 2 grown children.
-Denies tob, etoh 

### Response:
{'Hypotension, unspecified,Amyloidosis, unspecified,Immune thrombocytopenic purpura,Nutritional and metabolic cardiomyopathy,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Fever, unspecified'}
