Transfusion medicine: 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 · Transfusion medicine

Sample item

Within minutes of starting a red cell transfusion a patient develops fever, flank pain, hypotension and red urine. Which mechanism underlies this reaction?

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

The answer and the reasoning

D. Complement activation by preformed anti-A or anti-B antibodies

Acute haemolytic transfusion reaction is usually due to ABO mismatch. Recipient IgM isohaemagglutinins bind donor red cells, fix complement and cause intravascular haemolysis with haemoglobinuria, shock and DIC; it is a type II hypersensitivity.

Option by option

  • A. Cytokines released by stored donor leukocytes act on the recipient

    Cytokines from stored leukocytes cause a febrile non-haemolytic reaction with fever and chills but no haemoglobinuria.

  • B. Donor antibodies to recipient neutrophils injure pulmonary capillaries

    Donor antibodies against recipient neutrophils cause transfusion-related acute lung injury with non-cardiogenic pulmonary oedema.

  • C. Anti-IgA antibodies in an IgA-deficient recipient cause anaphylaxis

    Anti-IgA anaphylaxis presents with urticaria, wheeze and shock without haemolysis.

  • D. Complement activation by preformed anti-A or anti-B antibodies (correct)

    Complement-mediated intravascular lysis by preformed isoantibodies explains the picture.

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.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Complement activation by preformed anti-A or anti-B antibodies. Acute haemolytic transfusion reaction is usually due to ABO mismatch.

Why is "Cytokines released by stored donor leukocytes act on the recipient" not the answer?

Cytokines from stored leukocytes cause a febrile non-haemolytic reaction with fever and chills but no haemoglobinuria.

Why is "Donor antibodies to recipient neutrophils injure pulmonary capillaries" not the answer?

Donor antibodies against recipient neutrophils cause transfusion-related acute lung injury with non-cardiogenic pulmonary oedema.

Why is "Anti-IgA antibodies in an IgA-deficient recipient cause anaphylaxis" not the answer?

Anti-IgA anaphylaxis presents with urticaria, wheeze and shock without haemolysis.

What concept does this question test?

It tests Transfusion medicine in Pathology. Recipient IgM isohaemagglutinins bind donor red cells, fix complement and cause intravascular haemolysis with haemoglobinuria, shock and DIC; it is a type II hypersensitivity.

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 Transfusion medicine?

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.