Manik Madaan/med.psu.edu

Jul 6, 2026, 20:31

Manik Madaan: Master Transfusion Reactions for USMLE In Less Than 60 Seconds

Manik Madaan, Resident Doctor at Penn State University, shared a post on LinkedIn:

”Master Transfusion Reactions for USMLE In Less Than 60 Seconds

Acute Hemolytic Reaction (ABO mismatch)

Mechanism: type II hypersensitivity, recipient anti-A / anti-B antibodies attack donor red blood cells – intravascular hemolysis
Presentation: minutes to 24 hours; fever, chills, flank pain, hypotension, hemoglobinuria; can trigger DIC (disseminated intravascular coagulation)
Tx: STOP transfusion now, IV fluids; next step – Coombs (positive)

Febrile Non-Hemolytic Reaction (most common)

Mechanism: cytokines from donor white blood cells build up in storage (no hemolysis)
Presentation: 1 to 6 hours; fever plus chills; Coombs negative
Tx: stop to rule out hemolysis, then acetaminophen; prevent with leukoreduction

Allergic / Anaphylactic Reaction

Mechanism: type I hypersensitivity to donor plasma proteins; severe equals IgA (immunoglobulin A)-deficient patient with anti-IgA antibodies
Presentation: within minutes; mild equals hives plus itching (no fever); severe equals anaphylaxis
Tx: antihistamines; anaphylaxis equals epinephrine; washed / IgA-free products if IgA deficient

TRALI (transfusion-related acute lung injury)

Mechanism: donor anti-leukocyte antibodies activate lung neutrophils – non-cardiogenic pulmonary edema
Presentation: within 6 hours; dyspnea, hypoxia, bilateral infiltrates, fever plus LOW blood pressure, normal BNP (heart-strain marker)
Tx: stop, oxygen; top cause of transfusion death

TACO (transfusion-associated circulatory overload)

Mechanism: too much volume too fast – cardiogenic pulmonary edema
Presentation: after 6 hours (or heart disease); AFEBRILE plus HIGH blood pressure, high BNP, neck-vein distension
Tx: slow or stop transfusion, sit upright, diuretics

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Manik Madaan: Master Transfusion Reactions for USMLE In Less Than 60 Seconds