Blood transfusion decline

A case report of acute arsine poisoning in which a 27-y-old man was exposed to arsine during chemical manufacturing was reported by Pinto (1976). The subject was exposed to arsine as a result of arsine production via a reaction between a galvanized bucket and an arsenic-containing sulfuric acid solution. The exposure (duration not specified) produced toxic effects characterized by abdominal cramping, thoracic discomfort, and hematuria. Over the next week, the patient s hematocrit declined from 42.5 to 27.1 and hemoglobin dropped from 14.1 to 9.5 g/dL even with medical intervention (blood transfusions and mannitol diuresis). Nine hours after exposure, blood arsenic was 159 g/dL and urinary arsenic was 1862 ug/L. 

Why did the clinical staff decide to take action, after being explicitly told by a mentally competent patient that she declined certain kinds of care Although we have no inside information on this case, we suspect that certain biases were involved. When the patient lapsed into unconsciousness, the overconfidence and confirmation biases may have caused the staff to judge that they were correct about the life-saving necessity of a blood transfusion. The deformation professionnelle bias may have limited the treatment team s frame of reference to that of healer and left them unable... 

Kishimoto M, Ohto H, Shikama Y, et al. Treatment for the decline of ionized calciumlevels during peripheral blood progenitor cell harvesting. Transfusion 2002 42 1340-1347. 

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