Haematology and oncology: massive transfusion citrate effect: practice question

A General Medicine 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 Medicine · Haematology and oncology: massive transfusion citrate effect

Sample item

A trauma patient receives 12 units of stored red cells and plasma rapidly. He develops perioral tingling, hypotension and a prolonged QT interval. Which abnormality is the most likely cause?

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

The answer and the reasoning

B. Ionised hypocalcaemia from citrate

Blood products contain citrate, which chelates calcium. Rapid transfusion overwhelms hepatic metabolism of citrate and lowers ionised calcium, causing paraesthesia, hypotension and QT prolongation. Treatment is intravenous calcium.

Option by option

  • A. Hyperkalaemia from stored red cell leakage

    Hyperkalaemia gives peaked T waves and a wide QRS rather than a long QT.

  • B. Ionised hypocalcaemia from citrate (correct)

    Correct. Citrate binds calcium and the low ionised calcium explains tingling and QT prolongation.

  • C. Transfusion-associated circulatory overload

    Circulatory overload causes pulmonary oedema with hypertension.

  • D. Hypothermia-related bradycardia

    Hypothermia causes bradycardia and J waves but not perioral tingling.

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 Medicine question

What is the answer to this General Medicine question?

The best answer is B, Ionised hypocalcaemia from citrate. Blood products contain citrate, which chelates calcium.

Why is "Hyperkalaemia from stored red cell leakage" not the answer?

Hyperkalaemia gives peaked T waves and a wide QRS rather than a long QT.

Why is "Transfusion-associated circulatory overload" not the answer?

Circulatory overload causes pulmonary oedema with hypertension.

Why is "Hypothermia-related bradycardia" not the answer?

Hypothermia causes bradycardia and J waves but not perioral tingling.

What concept does this question test?

It tests Haematology and oncology: massive transfusion citrate effect in General Medicine. Rapid transfusion overwhelms hepatic metabolism of citrate and lowers ionised calcium, causing paraesthesia, hypotension and QT prolongation. Treatment is intravenous calcium.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Haematology and oncology: massive transfusion citrate effect?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.