frank100
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A 27 y/o woman is hospitalized after sustaining bilateral femoral shaft fractures in amotor vehicle colllision. 20 minutes after transfusion of 1 unit of RBC, she develops back, and flank pain, and hematurea. t: 38.5. which of the following is the most likely cause of these symptoms?
a) ABO incompatibility
b) Contamination of the transfused blood
c) Fat embolism syndrome
d) reaction to leukocytes antigen in the transfused blood
e) retroperitoneal bleeding
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| vnty
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ABO incompatibility
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| mazinger
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Ok, Im not sure of one thing.. does acute hemolysis/ATN produces back and flank pain?
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| frank100
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no, only capsule lesions hurt.
parenchimal lesions do not hurt.
so ATN due to hemolysys do not hurt. Or at least itīs not meant to...in medicine you never know.
but thatīs the rule
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| shadia
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it is (A)
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| radonc
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I thought it was E. retroperitoneal bleeding (causing urinary tract injury). It's the only thing that can explain the haematuria.
Some sort of haemolysis from transfusion incompatibility will result in excretion of bilirubin in urine, which would make the urine dark. But not red (which is the definition of haematuria).
The temperature could be non-specific. Some people with tissue necrosis/injury can have a fever.
What do others think?
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| Cedrick
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yeah baby
now the question
Renal infart,even though a short period of time
C.-Fat embolism
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| Cedrick
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ABO sound very good but the reactions does not fit the clinical stem
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| Cedrick
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Bone fracture pieces going all over the place, you know
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| frank100
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If it was a fat embolism, It would have been a great coincidence that not a single piece of that fat have gone to the heart and then to the lungs...
very selective fat embolus...
I still think itīs (a) : explains fast instauration of the signs and symptoms, kidney damage in such a massive way, and hematurea.
I was just thinking!!! please have mercy...
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| mazinger
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Fat embolism doesnt fit in too much either...
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| shumaila
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it is retroperitoneal bleeding
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| dtt
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it it a typical presentation of ABO incompatibility. back, and flank pain, and hematurea. there is no RBCs in urine, only HB
retroperitoneal bleeding can not cause hematuria, only oligourine
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| s2ckdeficient
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according to Merck medicus: Often ABO incompatability happens in less than 1 hour after transfusion & there may be severe pain in the lumbar area.
Im guessing the temperature of 38.5 is unrelated.
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