A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 34-year-old primigravida was brought to an obstetric clinic with a chief complaint of painless vaginal bleeding. She was diagnosed with placenta praevia and transfused with 2 units of whole blood. Five hours after the transfusion, she developed a fever and chills. How could the current situation be prevented?
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A
Performing Coombs test before transfusionIncorrect. A Coombs (direct antiglobulin) test detects RBC-bound antibodies but does not predict or prevent cytokine-mediated febrile non-hemolytic reactions.
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B
Administering prophylactic immunoglobulinsIncorrect. Prophylactic immunoglobulins (e.g., anti-D for Rh-negative mothers) prevent alloimmunization, not febrile non-hemolytic transfusion reactions.
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C
Transfusing leukocyte reduced blood productsCorrect. Leukoreduction filters out donor leukocytes and their cytokines, preventing the febrile non-hemolytic transfusion reaction caused by recipient anti-HLA antibodies and stored cytokines.
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D
ABO grouping and Rh typing before transfusionIncorrect. Pretransfusion ABO/Rh typing and crossmatching prevent acute hemolytic transfusion reactions; they do not prevent fevers from donor leukocytes or cytokines.
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E
Administering acetaminophen before transfusionIncorrect. Premedication with acetaminophen treats symptoms of an active febrile reaction but does not prevent the underlying donor-leukocyte and cytokine-mediated reaction; leukoreduction is the definitive preventive measure.
↑ Tap an answer to reveal the reasoning
Answer: C. A patient who develops fever and chills several hours after a non-emergent transfusion of whole blood, without hemolysis or hypotension, most likely had a febrile non-hemolytic transfusion reaction (FNHTR). FNHTR is caused by recipient antibodies reacting against donor leukocyte HLA antigens and by accumulated cytokines released from donor leukocytes during storage. It is the most common transfusion reaction overall, presenting as fever (>1 degree C rise), chills, and malaise within 1-6 hours, without evidence of hemolysis.
Prevention is straightforward: leukoreduction of blood products (filtration to remove >99% of donor white cells) before storage or at the bedside markedly reduces the incidence of FNHTR. Leukoreduction also lowers the risk of CMV transmission and HLA alloimmunization.
The other options would not prevent this reaction. A direct Coombs test before transfusion is not standard practice and would not detect cytokine-mediated FNHTR; pretransfusion ABO/Rh typing and antibody screening (type and crossmatch) prevent acute hemolytic reactions, not febrile non-hemolytic ones. Prophylactic immunoglobulins are used in selected immunodeficiencies and to prevent Rh alloimmunization (anti-D), not febrile reactions.
Clinical pearl: febrile non-hemolytic reactions are prevented by leukoreduction; allergic/urticarial reactions are prevented by washing the blood product; IgA-deficient patients with anti-IgA antibodies require washed or IgA-deficient products to prevent anaphylaxis.
**Why each option:**
**A.** A Coombs (direct antiglobulin) test detects RBC-bound antibodies but does not predict or prevent cytokine-mediated febrile non-hemolytic reactions.
**B.** Prophylactic immunoglobulins (e.g., anti-D for Rh-negative mothers) prevent alloimmunization, not febrile non-hemolytic transfusion reactions.
**C.** Correct. Leukoreduction filters out donor leukocytes and their cytokines, preventing the febrile non-hemolytic transfusion reaction caused by recipient anti-HLA antibodies and stored cytokines.
**D.** Pretransfusion ABO/Rh typing and crossmatching prevent acute hemolytic transfusion reactions; they do not prevent fevers from donor leukocytes or cytokines.