A patient receives a blood transfusion and within 15 minutes develops fever, rigors, hypotension, haemoglobinuria, and flank pain. The most likely diagnosis and initial management are:

• A Febrile non-haemolytic transfusion reaction; paracetamol and continue transfusion slowly
• B Transfusion-related acute lung injury (TRALI); mechanical ventilation and diuretics
• C Anaphylaxis; adrenaline 0.5 mg IM
• D Acute haemolytic transfusion reaction (ABO incompatibility); stop transfusion immediately, IV fluids, maintain urine output >100 mL/hour, notify blood bank ✓

Explanation

Acute haemolytic transfusion reaction due to ABO incompatibility presents with fever, haemoglobinuria, back/flank pain, hypotension, and disseminated intravascular coagulation — typically within minutes. Immediate management: stop the transfusion, keep IV access, aggressive IV fluids (normal saline) to maintain urine output >100 mL/hour and prevent acute tubular necrosis, and notify the blood bank urgently.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.