darkhorse
Forum Elite
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A 59-year-old man is admitted to the hospital for shortness of breath. The patient has a long-standing cardiac history and has suffered two non-Q wave infarctions in the past 20 months. The patient reports bright red blood in the toilet bowl during his last bowel movement. Laboratory data are remarkable for a hematocrit of 22%. Given the patient's known coronary disease, his attending cardiologist recommends a blood transfusion. As appropriate, you order 2 units of appropriately matched red bloods cells in order to transfuse the patient to a target hematocrit above 30%. While the first unit is being administered, the patient becomes febrile and develops chest and flank pain. You are immediately summoned to his side and on arrival you note erythema around the intravenous access site and a small volume of dark colored urine in his Foley catheter bag. The remainder of the physical examination is unremarkable. The most likely diagnosis is
A. acute febrile hemolytic reaction
B. anaphylaxis
C. delayed hemolytic transfusion reaction
D. pulmonary embolus
E. transfusion associated lung injury
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| dr penicillin
Forum Junior
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i think its A
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| doc_clotaire
Forum Guru
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Between A and C but delayed hemolytic transfusion reaction -----occurs after 24 hours
so I will go for A
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| darkhorse
Forum Elite
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well done guys!
Explanation: The correct answer is A. This patient is most likely having an acute febrile hemolytic reaction. This occurs when there is a mismatch between the patient's and donor's ABO types and classically presents with fever, chest/back pain, nausea, pain, and erythema around the infusion site and hemoglobinuria. Anaphylaxis (choice B) is unlikely given that the patient has no known drug allergies. Also, there is no mention of the bronchospasm or urticaria that would be expected with this process. A delayed hemolytic transfusion reaction (choice C) is also unlikely given the acuity of presentation. This reaction typically presents about 3-10 days following a transfusion reaction and has a mild course with fever and malaise.A pulmonary embolus (choice D) becomes less likely given that there is no mention of dyspnea or impaired oxygenation. There also is no mention of the classic physical stigmata of a pulmonary embolus such as a loud pulmonic component of the second heart sound or pulmonic tap. Transfusion associated lung injury (choice E) is unlikely given the acuity of symptoms. This process, which typically manifests as an acute lung injury type pathology, typically presents with a more delayed course.
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