NBME 24 Acute lung injury (NBME Answers)

NBME 24 Answers

nbme24/Block 1/Question#6 (reveal difficulty score)
A 57-year-old woman requires intubation in ...
Acute lung injury 🔍 / 📺 / 🌳
tags: respiratory transfusion transfusion_reactions

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+17
submitted by madeforupvoting2(14),

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PCAP saensicer eainlulatprr rserusep sa teh eeatvedl ryiwaa serpsuer is mtrntiasdte ot hoert insgth in het itvcay (nugl peshsu no pulearl ecp/vyataisc hhcwi anc hten husp no hoert tsscru.reu)t ihTs can edal ot iscnopeomrs fo seivn, nucigilnd hte evan avac gt-&; edsreeadc veosnu nutrer t-g;& aercddese pb ro(mf receedsad .deprlao) Tsih is mlaiirs ot wtha nephpsa nurigd lvsvaaal oe(xnteir hsse)ap hthuog eth svtiopei eeupsrsr si videdopr by a nceiamh pmup nidates of bnlmaaiod dc/sahilmau.repmgs I tkinh aerht reta lelkiy siecrsean etsdnia of cerdeaes sa a ntporcymoesa spn.eseor

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+8
submitted by ∗brethren_md(101),

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leraifsoaTnte-ursdn cauet guln uyijrn (IAT)LR is a arer utb iossreu odmsnrey eaczatehicrdr yb nudeds acuet rraystiproe tissrdse olngiwolf uosntai.fsnr tI is defeidn sa w,ne etuac lugn nuryji A(LI) dgunir ro ihniwt isx rhosu rftae olbod ptodurc irmtsanotndaii ni teh bcneeas of lmsoaypascieottlaedr- rkis sarctfo fro LA.I

drschmoctor Neutrophils sequestered in recipient lung are triggered by donor antigen (e.g., anti leukocyte IgG), which causes release of cytokines, inflammation party in the lungs. +8

+3
submitted by ∗mousie(259),

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sI 54 snitmeu oot ngol to eb alcyhactpian and wudlo eth acsbnee fo arsh t(r,iarciua rputuis)r OR laacniy?ahptc

hayayah Yes! Allergic/anaphylactic blood transfusion reaction is within minutes to 2-3 hours. (pg 114 of the 2019 FA has a list of them ordered by time) +10

hayayah (also allergy / anaphylactic presents with more skin findings (urticaria, pruritus) +9

seagull The time through me off too. I though ABO mismatch since it occured around an hour. I thought TRALI would take a little longer. +10

charcot_bouchard Guys anaphylactic reaction to whole blood doesnt occur much except for selective IgA defi. so look out for prev history of mucosal infection. And it can have all feature of type 1 HS inclding bronchospasm. +7

soph I saw hypotension and though anaphylaxis........ -.- +2

usmile1 Chest Xray showed "bilateral diffuse airspace disease". This is much more indicative of TRALI than anaphylaxis which would have wheezing and possibly respiratory arrest but no actual damage to the lungs. Additionally there was no urticaria or pruritus one would expect to see with anaphylaxis. +8

leemax you have to look out for- immediate(time is impt)reaction is Anaphylactic/allergic- you see type 1 symptoms(wheezing,urticaria). but if the reaction takes place with an hour(1)-think of type two (AntiBody mediated)-two types here , intravascular (ABO incomtability-you see hemoglobinuria and jaundine) or extravascular(DIC and + coombs). also don't forget -febrile hemolytic where cytokines that are accumulated during storage cause the reaction, here you see fever and chills. but in this question, they are asking about transfusion-related acute lung injury as seen in x-ray description, and this is due to the donor anti-leukocyte Ab acts against host neutrophils and pulmonary endothelial cells. +

+0
submitted by ∗unknown001(2),

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nodt be astrdtedci iwht .ngmiit b oth can start nihiwt nuimt.es

woh ot rlue tuo ?

sxayanahpli gnul ndfigin ;g&t HEWEE.Z si(otnequ mtse = no ee)wehz