A 50-Year-Old Woman Is Evaluated in the Post-Anesthesia Care Unit

A 50-year-old woman is evaluated in the post-anesthesia care unit due to sudden onset of severe nausea and right flank pain.  The patient underwent a total abdominal hysterectomy and tumor debulking for metastatic ovarian cancer.  The procedure was complicated by bleeding and a ureteral laceration that was repaired intraoperatively.  Immediately afterwards, her hemoglobin level was 6.8 g/dL.  A packed red blood cell transfusion was initiated 10 minutes ago.  Now, in addition to nausea and right flank pain, she has developed pain and oozing along the IV site.  Temperature is 38.5 C (101.3 F) , blood pressure is 90/50 mm Hg, pulse is 130/min, and respirations are 26/min.  Cardiac examination reveals tachycardia with weak pulses.  The lungs are clear bilaterally.  The skin examination is normal.  The urine is dark red.  Which of the following would most likely establish the diagnosis in this patient?

A) Blood culture
B) Cystoscopy
C) Direct Coombs test
D) IgA level
E) Renal ultrasound

Correct Answer:

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