Complications and emergencies: transfusion-related acute lung injury: practice question

A Anaesthesia 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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Anaesthesia · Complications and emergencies: transfusion-related acute lung injury

Sample item

Two hours after receiving fresh frozen plasma, a patient develops acute breathlessness, fever and hypoxaemia with bilateral fluffy infiltrates on chest X-ray. The jugular venous pressure and BNP are normal, and there is no response to a diuretic. What is the underlying mechanism?

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

The answer and the reasoning

A. Donor antibodies activating neutrophils in the lung

In transfusion-related acute lung injury, donor anti-HLA or anti-neutrophil antibodies, or lipids from stored blood, activate recipient neutrophils sequestered in the pulmonary capillaries. The resulting capillary leak gives non-cardiogenic oedema within six hours, with a normal BNP and no diuretic response, in contrast to circulatory overload.

Option by option

  • A. Donor antibodies activating neutrophils in the lung (correct)

    Correct. Neutrophil activation in the pulmonary capillaries causes a leaky non-cardiogenic oedema that appears soon after the transfusion.

  • B. Hydrostatic overload from rapid infusion in a stiff ventricle

    Hydrostatic overload would give a raised JVP and BNP and would improve with diuretics.

  • C. Complement-mediated lysis of donor red cells in the circulation

    Complement-mediated red cell lysis is the mechanism of an acute haemolytic reaction, with haemoglobinuria and flank pain.

  • D. Recipient IgE against donor plasma proteins causing bronchospasm

    IgE-mediated reactions cause urticaria, bronchospasm and hypotension, not diffuse 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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Donor antibodies activating neutrophils in the lung. In transfusion-related acute lung injury, donor anti-HLA or anti-neutrophil antibodies, or lipids from stored blood, activate recipient neutrophils sequestered in the pulmonary capillaries.

Why is "Hydrostatic overload from rapid infusion in a stiff ventricle" not the answer?

Hydrostatic overload would give a raised JVP and BNP and would improve with diuretics.

Why is "Complement-mediated lysis of donor red cells in the circulation" not the answer?

Complement-mediated red cell lysis is the mechanism of an acute haemolytic reaction, with haemoglobinuria and flank pain.

Why is "Recipient IgE against donor plasma proteins causing bronchospasm" not the answer?

IgE-mediated reactions cause urticaria, bronchospasm and hypotension, not diffuse infiltrates with fever.

What concept does this question test?

It tests Complications and emergencies: transfusion-related acute lung injury in Anaesthesia. The resulting capillary leak gives non-cardiogenic oedema within six hours, with a normal BNP and no diuretic response, in contrast to circulatory overload.

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 Complications and emergencies: transfusion-related acute lung injury?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia 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.