Examkin

Question

Difficulty: EasyHematology and Oncology

Match each clinical vignette describing an adverse reaction to a packed red blood cell (pRBC) transfusion with the most appropriate next step in management.

  • A 35-year-old male develops rapid-onset fever, severe flank pain, and dark urine 10 minutes after starting a pRBC transfusion.Stop the transfusion immediately and initiate aggressive intravenous hydration with normal saline
  • A 42-year-old female develops a temperature of 38.5°C (101.3°F) and chills 2 hours after the transfusion ends, with no other systemic symptoms.Rule out hemolysis and administer an antipyretic (e.g., acetaminophen) for symptom relief
  • A 28-year-old male develops acute severe dyspnea, hypoxemia, and diffuse bilateral pulmonary infiltrates with a normal blood pressure 4 hours into the transfusion.Stop the transfusion immediately and provide supportive respiratory care, including mechanical ventilation if necessary
  • A 19-year-old female develops intense pruritus and an urticarial rash on her chest during the infusion, with normal vital signs and no respiratory distress.Pause the transfusion, administer an antihistamine (e.g., diphenhydramine), and resume if symptoms resolve
  • A 78-year-old male with known systolic heart failure develops dyspnea, hypertension, and bilateral basilar crackles during his third unit of pRBCs.Stop or slow the transfusion, sit the patient upright, and administer intravenous furosemide

Answer

Acute hemolytic reaction matches with aggressive IV hydration; Febrile non-hemolytic reaction matches with administering an antipyretic; TRALI matches with supportive respiratory care; Allergic reaction matches with pausing, giving antihistamines, and resuming; and TACO matches with administering intravenous furosemide.
Each transfusion reaction has a distinct pathophysiologic mechanism that dictates its classic clinical presentation and subsequent management. Immediate life-threatening events like ABO incompatibility (Acute Hemolytic) require fluids to save the kidneys. Inflammatory but benign events (Febrile Non-Hemolytic) require simple antipyretics. Immune-mediated lung injury (TRALI) requires strict supportive respiratory care, while hydrostatic lung injury (TACO) requires aggressive diuresis. Finally, mild IgE-mediated reactions (Allergic) uniquely allow for pausing, treating the symptoms, and finishing the transfusion.

Step-by-Step Solution

1
Identify the cause of flank pain and dark urine shortly after starting a transfusion.
Matches aggressive IV hydration.
Diagnosis is an acute hemolytic reaction; fluids are essential to prevent pigment nephropathy and renal failure.
2
Evaluate isolated fever and chills without hemodynamic instability.
Matches antipyretic administration.
Diagnosis is a febrile non-hemolytic reaction, requiring only symptom control after ruling out hemolysis.
3
Distinguish the cause of respiratory distress with pulmonary infiltrates but normal blood pressure.
Matches supportive respiratory care.
Diagnosis is TRALI; immune-mediated capillary permeability requires respiratory support, not diuresis.
4
Identify the significance of isolated urticaria and pruritus without systemic signs.
Matches administering antihistamines and resuming.
Diagnosis is a mild allergic reaction; the blood product can safely be utilized after symptom resolution.
5
Evaluate respiratory distress accompanied by hypertension and basilar crackles in an elderly patient.
Matches intravenous furosemide.
Diagnosis is TACO; the acute volume overload must be reversed with rapid diuresis.

Key Concept

Management and identification of acute blood transfusion reactions
Rate this question

Topics

Hematology and Oncology

More questions from this topic