{"id":6011,"date":"2025-05-14T08:39:42","date_gmt":"2025-05-14T16:39:42","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=6011"},"modified":"2025-10-01T11:38:25","modified_gmt":"2025-10-01T19:38:25","slug":"usmle-step-2-ck-question-of-the-day-rbc-transfusion","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-rbc-transfusion","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0RBC transfusion"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-rbc-transfusion\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-rbc-transfusion\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-rbc-transfusion\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-rbc-transfusion\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-rbc-transfusion\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-rbc-transfusion\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today, we\u2019re examining a clinical case of a patient who&#8217;s undergoing a red blood cell transfusion. Thirty minutes into the transfusion, he suddenly develops dyspnea, cough, and chest tightness. What&#8217;s the next step in management?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 58-year-old man is undergoing a red blood cell transfusion. Thirty minutes into the transfusion, he suddenly develops dyspnea, cough, and chest tightness. Past medical history is significant for hypertension and type 2 diabetes mellitus. Temperature is 38.7\u00b0C (101.7\u00b0F), heart rate is 110\/min, blood pressure is 90\/50 mmHg, respiratory rate is 28\/min, and oxygen saturation is 88% on room air. On physical examination, he appears anxious and tachypneic. There is no rash or urticaria. Auscultation of the lungs reveals bilateral rales without wheezing. There is no lower extremity edema. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Which of the following is the <strong>best next step<\/strong> in management?<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Stop the blood transfusion and provide respiratory support<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Stop the blood transfusion and administer intravenous (IV) methylprednisolone<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Stop the blood transfusion and administer intravenous (IV) furosemide<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Continue the blood transfusion and administer intramuscular (IM) epinephrine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Continue the blood transfusion and initiate intravenous (IV) broad-spectrum antibiotics<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Stop the blood transfusion and provide respiratory support<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Stop the blood transfusion and administer intravenous (IV) methylprednisolone<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient likely has transfusion-related acute lung injury (TRALI). While the transfusion should be stopped, corticosteroids are not generally recommended for the treatment of TRALI. The immediate focus should be on providing respiratory support.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Stop the blood transfusion and administer intravenous (IV) furosemide<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect: <\/strong>This patient likely has transfusion-related acute lung injury (TRALI). Stopping the transfusion is appropriate, but administering IV furosemide is not an appropriate treatment of TRALI. It is indicated for transfusion-associated circulatory overload (TACO), which is characterized by volume overload; whereas TRALI involves noncardiogenic pulmonary edema.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Continue the blood transfusion and administer intramuscular (IM) epinephrine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Continuing the transfusion is contraindicated in the context of a suspected transfusion reaction. Epinephrine is used for anaphylactic reactions, not for transfusion-related acute lung injury (TRALI), and continuing the transfusion could worsen the patient\u2019s condition.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Continue the blood transfusion and initiate intravenous (IV) broad-spectrum antibiotics<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient likely has transfusion-related acute lung injury (TRALI). Continuing the blood transfusion in the presence of acute respiratory symptoms suggestive of a transfusion reaction is inappropriate. While the symptoms may mimic sepsis, the temporal relation to the transfusion is more suggestive of TRALI, and antibiotics are not indicated.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"503\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_b292da.png\" alt=\"TRALI\n* Supportive Care\n- Stop transfusion\n- Supplemental O2\n- +\/- Aggressive respiratory support - Mechanical ventilation\n\n* No diurectics (no fluid overload)\n* Consider IV fluids to address hypotension\n\" class=\"wp-image-6013\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_b292da.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_b292da.png?resize=300,155 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_b292da.png?resize=768,396 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient exhibits sudden onset dyspnea, cough, chest tightness, hypotension, and hypoxemia during a blood transfusion and most likely has transfusion-related acute lung injury (TRALI). TRALI is a life-threatening complication of blood transfusions that is characterized by acute respiratory distress and noncardiogenic pulmonary edema. It typically occurs during or shortly after a blood transfusion. Management of TRALI involves immediate cessation of the blood transfusion and immediate airway and hemodynamic stabilization.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">TRALI is caused by donor antibodies reacting against the recipient&#8217;s leukocytes, leading to capillary leak and pulmonary edema. The first step in management involves stopping the blood transfusion to prevent further exposure to donor antibodies. Next, patients should receive supportive care with oxygen and mechanical ventilation if needed. This condition can rapidly progress to severe hypoxemia and respiratory failure.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">TRALI is characterized by acute respiratory distress and noncardiogenic pulmonary edema. In cases of transfusion-related acute lung injury (TRALI), critical steps in management include stopping the blood transfusion and providing respiratory support.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pulmonary_transfusion_reactions:_Clinical_sciences\">Pulmonary transfusion reactions: Clinical sciences<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Semple JW, Rebetz J, Kapur R. Transfusion-associated circulatory overload and transfusion-related acute lung injury. Blood. 2019;133(17):1840-1853. doi:10.1182\/blood-2018-10-860809<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png\" alt=\"\" class=\"wp-image-4633\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 2 CK practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Explore today&#8217;s clinical case on managing red blood cell transfusion complications and the critical steps for patient care.<\/p>\n","protected":false},"author":202,"featured_media":6014,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,45],"tags":[734,730,733,265,84,731,156,732,670,729,185],"class_list":["post-6011","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-step-2","tag-acute-lung-injury","tag-blood-transfusion","tag-clinical-case","tag-healthcare-training","tag-medical-education","tag-patient-management","tag-patient-safety","tag-respiratory-distress","tag-step-2-ck","tag-trali","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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