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Acute Transfusion Reaction — RACP Paediatrics MCQ

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HardHaematology & OncologyAcute Transfusion ReactionRACP Paediatrics

Ninety minutes into a plasma-containing transfusion, an 8-year-old develops fever, acute dyspnoea, SpO₂ 78%, hypotension and bilateral pulmonary infiltrates. JVP is not elevated and echocardiography shows no new ventricular dysfunction. Which diagnosis-and-action pair is most appropriate?

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Reveal the answer and explanation

Correct answer: E — Suspect TRALI; stop permanently, support oxygenation and notify transfusion services

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

D is correct. Acute hypoxaemia, hypotension and non-cardiogenic bilateral pulmonary oedema during or within six hours of transfusion are characteristic of TRALI. The transfusion is stopped and not restarted; oxygen or ventilatory support and urgent transfusion-service notification are required. E is less consistent because TACO usually has circulatory overload and often hypertension or raised JVP, and transfusion should still be stopped. A cannot explain profound hypoxaemia and infiltrates. B cannot explain shock and pulmonary oedema. C occurs later and does not fit the immediate respiratory syndrome. The patient and component require the Lifeblood adverse-reaction investigation pathway.

Reference: Royal Children’s Hospital Melbourne: Adverse effects of transfusion: https://www.rch.org.au/bloodtrans/adverse_effects/Adverse_effects_of_transfusion/ Australian Red Cross Lifeblood: Transfusion-related acute lung injury: https://www.lifeblood.com.au/health-professionals/clinical-practice/adverse-events/TRALI Australian Red Cross Lifeblood: Management of suspected transfusion reactions: https://www.lifeblood.com.au/health-professionals/clinical-practice/adverse-events/management-of-suspected-reactions