Review the following clinical presentations of patients who develop complications during or shortly after receiving blood product transfusions. Match each patient's clinical scenario with the primary pathophysiologic mechanism responsible for their reaction.
- A 35-year-old woman develops fever and chills 2 hours after starting a packed red blood cell (PRBC) transfusion. Her temperature is 38.6°C (101.5°F). She is hemodynamically stable, has no respiratory distress, and her urine remains clear.Accumulation of leukocyte-derived cytokines during storage of the blood product
- A 52-year-old man receives fresh frozen plasma. Within 3 hours, he develops severe dyspnea, hypoxemia, and fever. Physical examination reveals crackles bilaterally but normal jugular venous pressure. Chest X-ray shows diffuse bilateral infiltrates.Donor anti-leukocyte antibodies binding to recipient neutrophils, causing endothelial damage and capillary leak
- A 78-year-old man with a history of ischemic cardiomyopathy receives 2 units of PRBCs rapidly. He subsequently develops worsening shortness of breath, a blood pressure of 170/95 mm Hg, elevated jugular venous pressure, and an S3 gallop.Rapid expansion of the intravascular space leading to increased hydrostatic pressure and transudation of fluid
- A 24-year-old woman develops sudden flank pain, fever, tachycardia, and dark red urine 15 minutes into a PRBC transfusion. Her blood pressure drops to 80/50 mm Hg, and oozing is noted from her intravenous catheter site.Preformed recipient IgM antibodies reacting against donor erythrocyte surface antigens, leading to complement activation
- A 29-year-old man with a history of recurrent sinopulmonary infections develops sudden onset stridor, wheezing, profound hypotension, and widespread urticaria within seconds of starting a platelet transfusion.Preformed recipient anti-IgA antibodies reacting against donor plasma IgA proteins, triggering mast cell degranulation
Cevap
The correct matches are: The 35-year-old with isolated fever matches cytokine accumulation (FNHTR). The 52-year-old with normal JVP and pulmonary infiltrates matches donor anti-leukocyte antibodies (TRALI). The 78-year-old with elevated JVP and S3 matches rapid volume expansion (TACO). The 24-year-old with flank pain and dark urine matches preformed recipient IgM (AHTR). The 29-year-old with immediate anaphylaxis matches recipient anti-IgA antibodies.
Each clinical vignette contains specific differentiating features that pinpoint the diagnosis. The timing (seconds vs hours), volume status (elevated vs normal JVP), and presence of end-organ damage (hemolysis, anaphylaxis) directly correlate with the five distinct pathophysiologic mechanisms of transfusion complications.
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Anahtar Kavram
Clinical presentation and pathophysiology of major transfusion reactions