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Lead screening — USMLE Step 3 MCQ

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HardPediatrics (Well-child / Chronic Management)Lead screeningUSMLE Step 3

During the second unit of red cells, a 78-year-old with HFrEF develops dyspnea, hypertension, jugular venous distention and bilateral pulmonary edema. BNP is increased and there is no fever or hypotension. What is the best immediate management?

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Correct answer: E — Stop transfusion, support oxygenation and give IV loop diuretic

The best answer is “Stop transfusion, support oxygenation and give IV loop diuretic”. The hypertension, elevated filling pressure and hydrostatic edema strongly indicate transfusion-associated circulatory overload rather than TRALI, anaphylaxis or septic transfusion reaction. The transfusion is stopped, oxygenation is supported and diuresis is used when tolerated; future transfusions require slower rates and smaller volume exposure.

Reference: AABB Association Bulletin: Transfusion-Associated Circulatory Overload: https://www.aabb.org/programs/publications/bulletins/Docs/ab15-02.pdf