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Acute haemolytic transfusion reaction — SCE Acute Medicine MCQ

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ModeratePatient Safety and Risk ManagementAcute haemolytic transfusion reactionSCE Acute Medicine

A 64-year-old woman develops fever and rigors 20 minutes after starting a red-cell transfusion. BP falls from 132/76 to 86/50 mmHg and she has loin pain and haemoglobinuria. The transfusion is stopped. What is the most likely diagnosis?

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Correct answer: B — Acute haemolytic transfusion reaction

Fever, hypotension, loin pain and haemoglobinuria shortly after starting transfusion suggest acute haemolytic transfusion reaction, usually from ABO incompatibility. Febrile non-haemolytic reactions are generally less severe and lack haemoglobinuria and shock. TACO presents with pulmonary oedema and hypertension or volume overload. Immediate actions include stopping transfusion, maintaining IV access, resuscitation and informing the transfusion laboratory.

Reference: BSH transfusion guideline, SHOT guidance