Blood transfusion reactions and transplant rejection: Pathology review

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Blood transfusion reactions and transplant rejection: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 50-year-old individual presents to the physician for evaluation of persistent diarrhea and a skin rash for the past week. The patient’s diarrhea began one week ago, is watery, and persists even during fasting. Yesterday, the patient noticed blood in the stool as well. In addition, the patient started experiencing a painful rash on their neck, shoulders, and the palms of their hands. The patient was diagnosed with acute leukemia six months ago and received a bone marrow transplantation two months ago after chemotherapy and radiotherapy. Vitals are within normal limits. On physical examination, a maculopapular rash is noted on the shoulders, arms, palms, and soles. Oral examination reveals the presence of mouth ulcers. On laboratory tests, serum alkaline phosphatase and serum bilirubin are elevated. Which of the following is the most likely cause of this patient’s condition?  


35 year old Adam is brought to the emergency department by an ambulance after being involved in a motor vehicle crash. Upon examination, you notice that he is significantly bleeding from his thigh, so you decide to give him a blood transfusion. Five minutes later, he develops shortness of breath, one episode of nonbloody vomiting, and a diffuse rash with erythematous borders starts to appear all over his body. Also, his blood pressure drops to 60 over 40 millimeters of mercury. Some days later, you see 50 year old Jack, who’s complaining of fever, malaise, and a decreased production of urine for the past two days. On further questioning, Jack tells you that he underwent a kidney transplantation one month ago. Upon examination, you realize that he has a high blood pressure of 150 over 80 millimeters of mercury. You decide to perform a biopsy of his transplanted kidney, which reveals a dense lymphocytic infiltrate.

Okay, based on the initial presentation, Adam seems to have some form of blood transfusion reaction, which includes any adverse event that occurs following blood transfusion. Jack, on the other hand, seems to be experiencing some form of transplant rejection, which is when the immune system of the recipient attacks the transplanted organ or graft.

All right, let’s start with blood transfusion reactions. For your tests, there are six blood transfusion reactions that you need to be aware of, including anaphylactic or allergic transfusion reaction, acute hemolytic transfusion reaction, delayed hemolytic transfusion reaction, febrile nonhemolytic transfusion reaction, transfusion-related acute lung injury, and transfusion-associated circulatory overload.


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