Blood Transfusion

Q: A 68-year-old man receives a blood transfusion. Within minutes he develops fever, rigors, back pain, hypotension, and hemoglobinuria. Direct Coombs test on post-transfusion sample is positive. Most likely type of transfusion reaction?

Acute hemolytic transfusion reaction. Immediate fever + back pain + hypotension + hemoglobinuria + positive Coombs = acute hemolytic transfusion reaction. Most often caused by ABO incompatibility from clerical error. Complement-mediated intravascular hemolysis is rapidly life-threatening. ---

Q: A 45-year-old woman receives a blood transfusion and develops sudden onset severe dyspnea and hypoxia within 2 hours. CXR shows bilateral pulmonary infiltrates. She is afebrile and not fluid overloaded. Her CVP is low. Most likely transfusion reaction?

Transfusion-related acute lung injury. Sudden dyspnea + bilateral infiltrates + within 6 hours of transfusion + not fluid overloaded + low CVP = TRALI (transfusion-related acute lung injury). Caused by donor antibodies against recipient neutrophils, activating them in pulmonary capillaries causing non-cardiogenic pulmonary edema. ---

Q: A 30-year-old woman with selective IgA deficiency receives a blood transfusion and immediately develops urticaria, angioedema, bronchospasm, and hypotension. Her temperature is normal. Most likely transfusion reaction?

Anaphylactic transfusion reaction. IgA deficiency + anti-IgA antibodies + immediate allergic reaction with urticaria, bronchospasm, hypotension = anaphylactic transfusion reaction. IgA-deficient patients form anti-IgA antibodies and react severely when exposed to IgA in transfused blood products. ---

Treat complications: hypoglycaemia (IV 10% dextrose), anaemia (blood transfusion if the haemoglobin is below 7 g/dL), convulsions (magnesium sulphate if eclampsia cannot be ruled out, or diazepam), and fever (paracetamol and tepid sponging).

Blood Transfusion

Simple transfusion — for severe anaemia, aplastic crisis, splenic sequestration
Exchange transfusion — for stroke, ACS, pre-operative; aim to reduce HbS to <30%
Chronic transfusion programme — for stroke prevention (Transcranial Doppler-guided)

Read this in Sickle Cell Disease: Pathology, Genetics & Mechanisms

What our notes say

Treat complications: hypoglycaemia (IV 10% dextrose), anaemia (blood transfusion if the haemoglobin is below 7 g/dL), convulsions (magnesium sulphate if eclampsia cannot be ruled out, or diazepam), and fever (paracetamol and tepid sponging). (Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 )
Circulation and haemorrhage control: two large-bore cannulae, send bloods, give a warmed crystalloid bolus (1 to 2 L, Ringer's lactate or saline), then blood transfusion early if there is no response, and tranexamic acid within 3 hours. (General Surgery CAT 2 (MBSG 4600): 4 October 2021)
Caesarean section and blood transfusion are comprehensive EmOC.* (Safe motherhood, maternal and newborn health)
A 16 year old non-European is referred for review in the haematology clinic with a history of 'thalassaemia' treated abroad with blood transfusions. (Haematology paper 1 Past Papers — Past Paper Questions & Answers)
Emergency (essential) obstetric care: basic and comprehensive services including caesarean section and blood transfusion. (Reproductive Health 1 End of Trimester CAT: 40 MCQs and 4 short answers)
Musonge, 5 years, has recurrent yellowing of the eyes, three blood transfusions and skull bossing. (Paediatrics end of fourth year main exam: 1 July 2019, Paper One, 99 of 100 MCQs)

Study material on Blood Transfusion

Practice questions on Blood Transfusion

A 68-year-old man receives a blood transfusion. Within minutes he develops fever, rigors, back pain, hypotension, and hemoglobinuria. Direct Coombs test on post-transfusion sample is positive. Most likely type of transfusion reaction?

Febrile non-hemolytic transfusion reaction
Transfusion-related acute lung injury
Acute hemolytic transfusion reaction
Anaphylactic transfusion reaction

Answer: C. Immediate fever + back pain + hypotension + hemoglobinuria + positive Coombs = acute hemolytic transfusion reaction. Most often caused by ABO incompatibility from clerical error. Complement-mediated intravascular hemolysis is rapidly life-threatening. ---

A 45-year-old woman receives a blood transfusion and develops sudden onset severe dyspnea and hypoxia within 2 hours. CXR shows bilateral pulmonary infiltrates. She is afebrile and not fluid overloaded. Her CVP is low. Most likely transfusion reaction?

Transfusion-associated circulatory overload
Acute hemolytic transfusion reaction
Anaphylactic transfusion reaction
Transfusion-related acute lung injury

Answer: D. Sudden dyspnea + bilateral infiltrates + within 6 hours of transfusion + not fluid overloaded + low CVP = TRALI (transfusion-related acute lung injury). Caused by donor antibodies against recipient neutrophils, activating them in pulmonary capillaries causing non-cardiogenic pulmonary edema. ---

A 30-year-old woman with selective IgA deficiency receives a blood transfusion and immediately develops urticaria, angioedema, bronchospasm, and hypotension. Her temperature is normal. Most likely transfusion reaction?

Febrile non-hemolytic transfusion reaction
Anaphylactic transfusion reaction
Delayed hemolytic transfusion reaction
Transfusion-related acute lung injury

Answer: B. IgA deficiency + anti-IgA antibodies + immediate allergic reaction with urticaria, bronchospasm, hypotension = anaphylactic transfusion reaction. IgA-deficient patients form anti-IgA antibodies and react severely when exposed to IgA in transfused blood products. ---

A 45-year-old man receives a blood transfusion and develops a low-grade fever and mild chills during the infusion. No hemoglobinuria, no hypotension, no dyspnea. Direct Coombs test is negative. Most likely transfusion reaction?

Acute hemolytic transfusion reaction
Anaphylactic transfusion reaction
Febrile non-hemolytic transfusion reaction
Transfusion-associated circulatory overload

Answer: C. Mild fever and chills during transfusion + no hemolysis + negative Coombs = febrile non-hemolytic transfusion reaction. Caused by recipient antibodies against donor leukocyte antigens or cytokines in stored blood. The most common transfusion reaction. Managed by slowing or stopping transfusion and giving antipyretics. ---

A 25-year-old man receives a blood transfusion during surgery. Ten days later he develops jaundice, a falling hemoglobin, and a newly positive direct Coombs test. He had no immediate reaction during the transfusion. Most likely explanation?

Febrile non-hemolytic transfusion reaction
Transfusion-associated graft-versus-host disease
Delayed hemolytic transfusion reaction
Acute hemolytic transfusion reaction

Answer: C. Jaundice + falling hemoglobin + positive Coombs appearing 5–10 days after transfusion = delayed hemolytic transfusion reaction. Caused by an anamnestic antibody response to donor RBC antigens (commonly Kidd, Duffy, or Kell) from prior sensitization. ---

A 62-year-old man with CLL receives a blood transfusion. Two weeks later he has fever, a maculopapular rash over the trunk, watery diarrhea, and his CBC shows pancytopenia. Skin biopsy shows lymphocytic infiltration with epidermal apoptosis. Most likely complication?

Cytomegalovirus reactivation
Drug reaction to recent antibiotics
Delayed hemolytic transfusion reaction
Transfusion-associated graft-versus-host disease

Answer: D. CLL (immunocompromised) + non-irradiated transfusion + rash + diarrhea + pancytopenia + epidermal apoptosis on biopsy = transfusion-associated GVHD. Unlike bone marrow GVHD, this is almost universally fatal with no effective treatment. Prevention by irradiation is critical. ---

Blood Transfusion

Blood Transfusion

What our notes say

Study material on Blood Transfusion

Practice questions on Blood Transfusion

A 68-year-old man receives a blood transfusion. Within minutes he develops fever, rigors, back pain, hypotension, and hemoglobinuria. Direct Coombs test on post-transfusion sample is positive. Most likely type of transfusion reaction?

A 45-year-old woman receives a blood transfusion and develops sudden onset severe dyspnea and hypoxia within 2 hours. CXR shows bilateral pulmonary infiltrates. She is afebrile and not fluid overloaded. Her CVP is low. Most likely transfusion reaction?

A 30-year-old woman with selective IgA deficiency receives a blood transfusion and immediately develops urticaria, angioedema, bronchospasm, and hypotension. Her temperature is normal. Most likely transfusion reaction?

A 45-year-old man receives a blood transfusion and develops a low-grade fever and mild chills during the infusion. No hemoglobinuria, no hypotension, no dyspnea. Direct Coombs test is negative. Most likely transfusion reaction?

A 25-year-old man receives a blood transfusion during surgery. Ten days later he develops jaundice, a falling hemoglobin, and a newly positive direct Coombs test. He had no immediate reaction during the transfusion. Most likely explanation?

A 62-year-old man with CLL receives a blood transfusion. Two weeks later he has fever, a maculopapular rash over the trunk, watery diarrhea, and his CBC shows pancytopenia. Skin biopsy shows lymphocytic infiltration with epidermal apoptosis. Most likely complication?

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