Endocrine, Hematology/Immunology, GI, Renal/GU, IntegumentaryDifficulty 3/5
Two hours into a transfusion a patient develops hypoxaemia and bilateral pulmonary infiltrates with a normal central venous pressure and no response to diuretics. What is the most likely reaction?
- AAcute haemolytic transfusion reaction from ABO incompatibility
- BFebrile non-haemolytic reaction to donor leukocytes
- CTransfusion-associated circulatory overload from excessive volume
- DTransfusion-related acute lung injury, an immune non-cardiogenic oedema
Show answer and rationale
Correct: D. TRALI produces non-cardiogenic pulmonary oedema within about six hours of transfusion, with normal filling pressures and no diuretic response. TACO is volume overload with raised filling pressures that improves with diuresis.
- C — Circulatory overload raises filling pressures and responds to diuretics.
- A — Haemolysis presents with fever, flank pain, haemoglobinuria and shock rather than isolated infiltrates.
- B — A febrile reaction causes fever without pulmonary infiltrates.