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|Prompt=A 43-year-old man with history of chronic gastritis presents to the emergency department for several episodes of bloody emesis that started a few hours after his last meal. On admission, the patient is alert and oriented but complains of severe, continuous epigastric pain. His blood pressure is 90/62 mm Hg, heart rate is 130/min, and temperature is 36.7 ᵒC (98 ᵒF). After initial fluid resuscitation, the patient improves and his vitals stabilize. Gastroduodenoscopy reveals a 2.5 cm crusted ulcer in the duodenal bulb. The following day, the patient's hematocrit drops to 6.7 g/dL. He is typed and cross-matched and receives 2 units of red blood cells. Within 10 minutes of initiating the transfusion, the patient complains of generalized pruritus. Physical exam reveals a skin rash apparent mostly on the trunk and upper extremities (shown below). The transfusion is discontinued and vitals remain stable. The patient does not develop fever over the next 4 hours. Which of the following most likely etiology of the transfusion reaction in this patient? | |Prompt=A 43-year-old man with history of chronic gastritis presents to the emergency department for several episodes of bloody emesis that started a few hours after his last meal. On admission, the patient is alert and oriented but complains of severe, continuous epigastric pain. His blood pressure is 90/62 mm Hg, heart rate is 130/min, and temperature is 36.7 ᵒC (98 ᵒF). After initial fluid resuscitation, the patient improves and his vitals stabilize. Gastroduodenoscopy reveals a 2.5 cm crusted ulcer in the duodenal bulb. The following day, the patient's hematocrit drops to 6.7 g/dL. He is typed and cross-matched and receives 2 units of red blood cells. Within 10 minutes of initiating the transfusion, the patient complains of generalized pruritus. Physical exam reveals a skin rash apparent mostly on the trunk and upper extremities (shown below). The transfusion is discontinued and vitals remain stable. The patient does not develop fever over the next 4 hours. Which of the following most likely etiology of the transfusion reaction in this patient? | ||
|Explanation=transfusion reaction | |Explanation=transfusion reaction | ||
|AnswerA= | |AnswerA=Plasma proteins in transfused blood | ||
|AnswerB= | |AnswerB=Cytokines from leukocytes in donor blood | ||
|AnswerC= | |AnswerC=Host antibodies against antigens on donor RBCs | ||
|AnswerD= | |AnswerD=Host antibodies against donor MHC antigens | ||
|AnswerE= | |AnswerE=Host antibodies against donor IgA molecules | ||
|RightAnswer=A | |RightAnswer=A | ||
|WBRKeyword=transfusion, transfusion reactions, IgA, non-hemolytic febrile transfusion reaction, NHFTR, hypersensitivity reactions, hypersensitivity, blood transfusion | |WBRKeyword=transfusion, transfusion reactions, IgA, non-hemolytic febrile transfusion reaction, NHFTR, hypersensitivity reactions, hypersensitivity, blood transfusion | ||
|Approved=Yes | |Approved=Yes | ||
}} | }} | ||
Revision as of 18:55, 28 August 2014
| Author | [[PageAuthor::Serge Korjian M.D.(Reviewed by Serge Korjian)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Embryology, MainCategory::Pathology |
| Sub Category | SubCategory::Reproductive |
| Prompt | [[Prompt::A 43-year-old man with history of chronic gastritis presents to the emergency department for several episodes of bloody emesis that started a few hours after his last meal. On admission, the patient is alert and oriented but complains of severe, continuous epigastric pain. His blood pressure is 90/62 mm Hg, heart rate is 130/min, and temperature is 36.7 ᵒC (98 ᵒF). After initial fluid resuscitation, the patient improves and his vitals stabilize. Gastroduodenoscopy reveals a 2.5 cm crusted ulcer in the duodenal bulb. The following day, the patient's hematocrit drops to 6.7 g/dL. He is typed and cross-matched and receives 2 units of red blood cells. Within 10 minutes of initiating the transfusion, the patient complains of generalized pruritus. Physical exam reveals a skin rash apparent mostly on the trunk and upper extremities (shown below). The transfusion is discontinued and vitals remain stable. The patient does not develop fever over the next 4 hours. Which of the following most likely etiology of the transfusion reaction in this patient?]] |
| Answer A | AnswerA::Plasma proteins in transfused blood |
| Answer A Explanation | AnswerAExp:: |
| Answer B | AnswerB::Cytokines from leukocytes in donor blood |
| Answer B Explanation | AnswerBExp:: |
| Answer C | AnswerC::Host antibodies against antigens on donor RBCs |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD::Host antibodies against donor MHC antigens |
| Answer D Explanation | AnswerDExp:: |
| Answer E | AnswerE::Host antibodies against donor IgA molecules |
| Answer E Explanation | AnswerEExp:: |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::transfusion reaction Educational Objective: |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::transfusion, WBRKeyword::transfusion reactions, WBRKeyword::IgA, WBRKeyword::non-hemolytic febrile transfusion reaction, WBRKeyword::NHFTR, WBRKeyword::hypersensitivity reactions, WBRKeyword::hypersensitivity, WBRKeyword::blood transfusion |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |