Perioperative care: transfusion-related acute lung injury: practice question

A General Surgery 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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General Surgery · Perioperative care: transfusion-related acute lung injury

Sample item

Two hours after transfusion of fresh frozen plasma, a patient has sudden dyspnoea, fever, hypotension and bilateral pulmonary infiltrates. The jugular venous pressure is not raised and there is no response to diuretics. What is the most likely diagnosis?

AFebrile non-haemolytic reactionBTransfusion-associated circulatory overloadCTransfusion-related acute lung injuryDAnaphylactic transfusion reaction

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

The answer and the reasoning

C. Transfusion-related acute lung injury

TRALI presents within six hours with hypoxia and non-cardiogenic pulmonary oedema, with fever and hypotension. Donor antibodies to recipient leucocyte antigens are implicated. In contrast to circulatory overload, the venous pressure is not raised and diuretics are of no help. Management is supportive with oxygen and ventilation.

Option by option

A. Febrile non-haemolytic reaction
A febrile non-haemolytic reaction gives fever and chills but no respiratory failure.
B. Transfusion-associated circulatory overload
Circulatory overload gives hypertension and a raised venous pressure and responds to diuretics.
C. Transfusion-related acute lung injury (correct)
Correct. Non-cardiogenic oedema with hypotension and normal venous pressure within hours is characteristic of TRALI.
D. Anaphylactic transfusion reaction
Anaphylaxis presents with urticaria, bronchospasm and angioedema rather than isolated bilateral infiltrates.

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 General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Transfusion-related acute lung injury. TRALI presents within six hours with hypoxia and non-cardiogenic pulmonary oedema, with fever and hypotension.

Why is "Febrile non-haemolytic reaction" not the answer?

A febrile non-haemolytic reaction gives fever and chills but no respiratory failure.

Why is "Transfusion-associated circulatory overload" not the answer?

Circulatory overload gives hypertension and a raised venous pressure and responds to diuretics.

Why is "Anaphylactic transfusion reaction" not the answer?

Anaphylaxis presents with urticaria, bronchospasm and angioedema rather than isolated bilateral infiltrates.

What concept does this question test?

It tests Perioperative care: transfusion-related acute lung injury in General Surgery. Donor antibodies to recipient leucocyte antigens are implicated. In contrast to circulatory overload, the venous pressure is not raised and diuretics are of no help. Management is supportive with oxygen and ventilation.

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 Perioperative care: transfusion-related acute lung injury?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.