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Acute Haemolytic Transfusion Reaction — RACP Adult Medicine MCQ

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EasyHaematologyAcute Haemolytic Transfusion ReactionRACP Adult Medicine

A 60-year-old man undergoes a transfusion of packed red blood cells. Within 30 minutes he develops fever (39°C), rigors, flank pain, and dark urine. BP drops to 80/50 mmHg. The blood bag label matches the patient wristband, but the blood group is mismatched (patient is group A, unit is group B). What is the most likely transfusion reaction?

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Correct answer: E — Acute haemolytic transfusion reaction

Fever, rigors, flank pain, dark urine (haemoglobinuria), and hypotension within minutes of starting an ABO-incompatible transfusion is an acute haemolytic transfusion reaction. It is the most feared transfusion complication. Management: STOP transfusion immediately, IV saline resuscitation, send samples for DAT, repeat group and crossmatch, and monitor for DIC and AKI.

Reference: Australian Red Cross Lifeblood – 2024 – Transfusion Reaction Guidelines; ANZSBT