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NBME 22 Answers

nbme22/Block 2/Question#9

A 26-year-old woman develops hypotension and ...

Antibody, complement C5-9

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submitted by mattnatomy(21),

Diagnosis: Acute Hemolytic Transfusion Reaction

Pathogenesis:

Type II hypersensitivity reaction. Intravascular hemolysis (ABO blood group incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs).

Presentation:

Fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinuria (intravascular hemolysis), jaundice (extravascular). Within 1 hour.





 +1  upvote downvote
submitted by potato_for_brains(1),

This is acute hemolytic transfusion reaction, I believe. Type II HSR so she’s forming antibodies against the ABO groups on the blood cells. Complement is induced by antibodies.

kfratta1  But with hypotension in the stem I thought more of anaphylaxis due to IgA def. Why would a T2 HSR give you hypotension? +1  
2ndmedschool  I think the hemoglobinuria is the key. As I’m looking at it it seems that anaphylaxis would cause hypotension, urticaria, itching, wheezing. ABO incompatibility is the only one that mentions hemoglobinuria. +2  
hyperfukus  abo incompatibility and rh incompatibility with mom blood rxns are gonna TYPE 2 no matter what it looks like +