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NBME 20 Answers

nbme20/Block 4/Question#49 (43.4 difficulty score)
A 23-year-old woman sustains significant ...
Direct antiglobulin testπŸ”
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 +2 
submitted by sympathetikey(1253),
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ergogenic22  there is a delayed onset hemolytic transfusion reaction which should be evaluated with direct cooms test. https://www.ncbi.nlm.nih.gov/books/NBK448158/ +5  
hungrybox  such a dumb question wtf +25  
sonichedgehog  takess longer due to slow destruction by RES +  
baja_blast  Dang, I didn't know that was the same thing as a direct Coombs test. I guess it makes sense in hindsight. Thanks! +  
sars  Theres a UWORLD question with a table displaying the different types of hemolytic reactions. Don't know the question ID. Agree with delayed hemolytic transfusion reaction due to formation of antibodies against donor non ABO antigens. Typically presents as an asymptomatic patient or mild symptoms (jaundice, anemia). Different from an acute hemolytic transfusion reaction, which is against ABO antigens. +1  
tomatoesandmoraxella  The Uworld table is in question 17780 +1  



 +0 
submitted by victor_abdullatif(0),

I think this is delayed hemolytic transfusion reaction (which is why it took 4 weeks and she is not exhibiting signs and symptoms of shock).


From AMBOSS:

Pathomechanism: Occurs in patients who were previously sensitized to specific RBC antigens during transfusions, pregnancy, or transplantations. Re-exposure to the antigens results in a rapid increase in antibodies that bind to donor RBCs and cause extravascular hemolysis

Clinical features: Onset days or weeks after transfusion. Fever, jaundice, anemia, dark urine

Diagnostics: Antibody testing to prevent future reactions

Treatment: No acute therapy required


Regardless of whether it is acute or delayed hemolytic, they are both diagnosed with "direct antiglobulin test"