Perioperative: transfusion reaction: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Perioperative: transfusion reaction

Sample item

Twenty minutes into a red cell transfusion, a patient develops fever, rigors, loin pain, hypotension and passes red urine. What is the first action?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Stop the transfusion, keep the line open with saline and recheck identity details

These features suggest an acute haemolytic transfusion reaction, usually from ABO incompatibility due to a clerical error. The first step is to stop the transfusion, maintain venous access with saline, check patient and unit identifiers, resuscitate, and send samples to the blood bank. Supportive care includes fluids to maintain urine output. Delay increases the risk of renal failure and DIC.

Option by option

  • A. Give an antihistamine and continue the transfusion

    Antihistamines treat mild allergic reactions, not haemolysis.

  • B. Continue the transfusion with intravenous furosemide

    Continuing the transfusion would give more incompatible red cells.

  • C. Slow the transfusion and give paracetamol

    Slowing the rate is for a mild febrile reaction and would continue the incompatible exposure.

  • D. Stop the transfusion, keep the line open with saline and recheck identity details (correct)

    Stopping the incompatible blood limits ongoing haemolysis and confirms the cause.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Stop the transfusion, keep the line open with saline and recheck identity details. These features suggest an acute haemolytic transfusion reaction, usually from ABO incompatibility due to a clerical error.

Why is "Give an antihistamine and continue the transfusion" not the answer?

Antihistamines treat mild allergic reactions, not haemolysis.

Why is "Continue the transfusion with intravenous furosemide" not the answer?

Continuing the transfusion would give more incompatible red cells.

Why is "Slow the transfusion and give paracetamol" not the answer?

Slowing the rate is for a mild febrile reaction and would continue the incompatible exposure.

What concept does this question test?

It tests Perioperative: transfusion reaction in General Surgery. The first step is to stop the transfusion, maintain venous access with saline, check patient and unit identifiers, resuscitate, and send samples to the blood bank. Supportive care includes fluids to maintain urine output. Delay increases the risk of renal failure and DIC.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Perioperative: transfusion reaction?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.