Transfusion Reaction: The Daily PANCE Blueprint
A 52-year-old patient is admitted with a lower gastrointestinal bleed. He is given 2 units of packed red blood cells. A few hours later the patient develops a fever but has no other symptoms or changes in vital signs. Lab studies reveal no significant changes. Which of the following is the most likely diagnosis?
A. Transfusion-associated circulatory overload
B. Acute immune-mediated hemolytic reaction
C. Transfusion-related acute lung injury
D. Febrile non-hemolytic transfusion reaction
E. None of the above
Answer and topic summary
The answer is D. Febrile non-hemolytic transfusion reaction
The most common transfusion reaction is a febrile non-hemolytic transfusion reaction (FNHTR).
Patients with FNHTR may present with a fever a few hours after receiving packed red blood cells (PRBCs), which is caused by the small number of white blood cells and cytokines that can be found in each unit of PRBCs. Treatment consists of giving acetaminophen and ruling out other causes of fever (e.g., central line infection, urinary tract infection, etc).
Incorrect Answers:
Transfusion-associated circulatory overload (Choice A) occurs when the volume of the transfused component causes hypervolemia.
Acute immune-mediated hemolytic reaction (Choice B) occurs when there are antibodies presented to blood donor antigens. Patients may present with hypotension, fever, or coagulopathic lab abnormalities.
Transfusion-related acute lung injury (Choice C) is due to antibodies reacting with antigens leading to the release of mediators that causes edema in the lungs. Symptoms include fever, hypoxia, and dyspnea.
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Covered under ⇒ PANCE Blueprint Hematology ⇒ ⇒
