Transfusion Reactions: The Daily PANCE Blueprint
A 70-year-old male receiving a blood transfusion develops sudden shortness of breath, hypoxia, and fever. On examination, he has bilateral crackles. Which of the following is the most likely cause?
A. Febrile non-hemolytic transfusion reaction
B. Acute hemolytic transfusion reaction
C. Transfusion-related acute lung injury
D. Transfusion-associated circulatory overload
E. Allergic transfusion reaction
Answer and topic summary
The answer is C. Transfusion-related acute lung injury
Common Types of Transfusion Reactions
- Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
- Cause: Cytokines and residual WBCs in transfused PRBCs
- Presentation: Fever a few hours after transfusion; usually no hypotension or hemolysis
- Management: Acetaminophen and rule out other sources of fever
- Transfusion-Associated Circulatory Overload (TACO)
- Cause: Volume overload from rapid or excessive transfusion
- Presentation: Dyspnea, pulmonary edema, hypertension
- Management: Slow transfusion rate and/or administer diuretics
- Acute Hemolytic Transfusion Reaction
- Cause: Immune-mediated destruction of donor RBCs by recipient antibodies.
- Presentation: Fever, chills, hypotension, back pain, hemoglobinuria, coagulopathy.
- Management: Stop the transfusion immediately
- Transfusion-Related Acute Lung Injury (TRALI)
- Cause: Donor antibodies react with recipient leukocytes, causing pulmonary edema.
- Presentation: Fever, hypoxia, dyspnea, pulmonary edema
- Management: Stop the transfusion; supportive respiratory care
- Allergic Transfusion Reaction
- Cause: Recipient reaction to donor plasma proteins.
- Presentation: Hives, pruritus; may progress to anaphylaxis
- Management: Antihistamines; transfusion may continue if mild and no anaphylaxis.
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