Haematology: febrile non-haemolytic transfusion reaction: practice question

A Pathology 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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Pathology · Haematology: febrile non-haemolytic transfusion reaction

Sample item

A 12-year-old with thalassaemia major develops fever of 38.8 C and chills during a transfusion. Blood pressure is normal, there is no urticaria, urine is clear, the direct antiglobulin test is negative and cultures are sterile. She has had two similar episodes. Which measure best reduces recurrence?

APre-storage leucocyte-reduced red cell unitsBWashing the red cells with salineCUsing only group O Rh-negative unitsDGamma irradiation of the units

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

The answer and the reasoning

A. Pre-storage leucocyte-reduced red cell units

Febrile non-haemolytic reactions arise from cytokines released by leucocytes in stored units or from recipient antibodies to donor leucocytes. Removing leucocytes before storage lowers the cytokine load and the antigen exposure.

Option by option

A. Pre-storage leucocyte-reduced red cell units (correct)
Correct. Leucocyte reduction removes the cells that release pyrogenic cytokines during storage.
B. Washing the red cells with saline
Washing is used mainly for recipients with IgA deficiency or recurrent allergic reactions to plasma proteins.
C. Using only group O Rh-negative units
ABO and Rh group choice has no bearing on a reaction with a negative antiglobulin test.
D. Gamma irradiation of the units
Irradiation inactivates donor lymphocytes to prevent graft-versus-host disease and does not stop cytokine-related fever.

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.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Pre-storage leucocyte-reduced red cell units. Febrile non-haemolytic reactions arise from cytokines released by leucocytes in stored units or from recipient antibodies to donor leucocytes.

Why is "Washing the red cells with saline" not the answer?

Washing is used mainly for recipients with IgA deficiency or recurrent allergic reactions to plasma proteins.

Why is "Using only group O Rh-negative units" not the answer?

ABO and Rh group choice has no bearing on a reaction with a negative antiglobulin test.

Why is "Gamma irradiation of the units" not the answer?

Irradiation inactivates donor lymphocytes to prevent graft-versus-host disease and does not stop cytokine-related fever.

What concept does this question test?

It tests Haematology: febrile non-haemolytic transfusion reaction in Pathology. Removing leucocytes before storage lowers the cytokine load and the antigen exposure.

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: febrile non-haemolytic transfusion reaction?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.