Haematology: transfusion-related acute lung injury: 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: transfusion-related acute lung injury

Sample item

A 60-year-old man with a bleed receives fresh frozen plasma. Within an hour he has fever, hypotension and severe dyspnoea. His JVP is not raised, chest radiograph shows bilateral infiltrates, and the BNP is low. Which mechanism is most likely?

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

The answer and the reasoning

C. Donor anti-HLA or anti-neutrophil antibodies activating recipient neutrophils in the lung

Transfusion-related acute lung injury occurs within 6 hours and produces non-cardiogenic pulmonary oedema, with hypoxia, fever and often hypotension. Antibodies in donor plasma, usually from multiparous women, bind recipient leucocytes that become sequestered in pulmonary capillaries and injure the endothelium. Management is supportive, and implicated donors are excluded.

Option by option

  • A. Recipient anti-A antibodies destroying donor red cells

    ABO haemolysis causes fever, haemoglobinuria and renal injury, with lungs usually clear.

  • B. Circulatory overload from the volume transfused

    Circulatory overload gives raised JVP, high BNP and hypertension, and improves with diuretics.

  • C. Donor anti-HLA or anti-neutrophil antibodies activating recipient neutrophils in the lung (correct)

    Donor leucocyte antibodies cause neutrophil-mediated capillary leak with a normal JVP and low BNP.

  • D. Anti-IgA antibodies in an IgA-deficient recipient

    Anti-IgA reactions cause anaphylaxis with bronchospasm and urticaria, and not pulmonary infiltrates with 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.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Donor anti-HLA or anti-neutrophil antibodies activating recipient neutrophils in the lung. Transfusion-related acute lung injury occurs within 6 hours and produces non-cardiogenic pulmonary oedema, with hypoxia, fever and often hypotension.

Why is "Recipient anti-A antibodies destroying donor red cells" not the answer?

ABO haemolysis causes fever, haemoglobinuria and renal injury, with lungs usually clear.

Why is "Circulatory overload from the volume transfused" not the answer?

Circulatory overload gives raised JVP, high BNP and hypertension, and improves with diuretics.

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

Anti-IgA reactions cause anaphylaxis with bronchospasm and urticaria, and not pulmonary infiltrates with fever.

What concept does this question test?

It tests Haematology: transfusion-related acute lung injury in Pathology. Antibodies in donor plasma, usually from multiparous women, bind recipient leucocytes that become sequestered in pulmonary capillaries and injure the endothelium. Management is supportive, and implicated donors are excluded.

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 Haematology: transfusion-related acute lung injury?

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.