Step 2

Hematology 6

A 55-year-old man presents to the emergency department with a 10-day history of fatigue, shortness of breath, and lightheadedness with minimal exertion. He is found to have a hemoglobin concentration of 6.7 g/dL. He is consented for a blood transfusion which is started. He is admitted to the hospital for further evaluation. 3 hours after transfusion of 1 unit of packed red blood cells, he develops fever and chills. His temperature is 38.8°C (101.8°F), blood pressure is 118/67 mmHg, pulse is 112/min, respirations are 18/min. On physical examination, he appears pale and has tachycardia. The remainder of the examination shows no abnormalities. His hemoglobin concentration is measured again and is 7.7 g/dL. Direct Coombs test is negative. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and platelet counts are all within normal limits. Urinalysis is unremarkable. Blood cultures are drawn.

Which of the following is the most likely explanation for this patient's fever?

  • A) Bacterial contamination of the transfused blood
  • B) Hemolytic transfusion reaction
  • C) Human immunodeficiency virus (HIV) infection from the transfused blood
  • D) IgA deficiency
  • E) Release of cytokines from the transfused blood


Lloyd Taylor


Dr. Ted O'Connell

Last updated

Jun 09, 2024

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