This occurred within 6 hours and caused some pulmonary edema and respiratory distress after a transfusion caused by the donor's anti-leukocyte antibodies just destroying the recipients neutrophils and respiratory endothelial cells.

while allergic/anaphylaxis can cause respiratory arrest and shock it has a somewhat different picture, no wheezing, itchiness or whatever and according to first Aid it happens within minutes to 2-3 hours which is at least double what we're seeing here. also beware of IgA deficient people in this choice.

PE, eh I don't think it affects Pao2 that often much according to this super duper high yield resource. but uhh yeah doesn't feel PE kinda question https://emedicine.medscape.com/article/300901-workup#c12

pneomina, right after all the infusion business and no mention of fever or anything? Nah.

go to page 114 of first aid. I'm pretty sure we need to know our infusion/transplant crap because it just keeps coming up in uworld but this whole exam is a crapshoot.

Forgive me if I made a mistake/wrong about anything, I mostly got info from first aid. plz correct if there is a mistake, good luck.

I’m trying to really learn this and know how to rule out all the answer choices. So far I have:

A: Anaphylactic reaction induced by IgA antibodies <2-3 hrs

B: Hemolytic transfusion reaction <1 hr

C: Postoperative bronchopneumonia Pneumonia, right after all the infusion business and no mention of fever or anything? Nah

D: Pulmonary embolus with pulmonary infarction

E: Transfusion-related acute lung injury Correct! Occurs <6 hrs

I was thinking D could be ruled out b/c there’s no mention of history of immobilization/hyper-coagulable states. And I guess it seems obvious the question is focusing on the transfusion. Seems kinda iffy though. What do you guys think?

i would highly recommend you refrain from cramming of exact timings , as some over lap , and the wordings can be misleading,

for example, within 6 hours, can be interpreted as an event that starts in few minutes, as few minutes are part of the "within 6 hours"

ignore timing and let common sense take care of it , lets go for pathogenesis.

allergic/anaphylactic= broncoconstriction and wheez vasodilat. > third spacing > shock

trasnfusion rel. acute lung injury = host neutrophil activated by donor blood product > cytokine release in pulmoanry vasc. > pulmanry edema

https://professionaleducation.blood.ca/en/transfusion/publications/transfusion-related-acute-lung-injury-trali