Question

A patient was transfused 4 units of blood 2 hours ago, and now she complains of chest discomfort. X-ray shows bilateral fissural thickening. Which of the following is the most probable cause ?

• A. ABO incompatibility reactions
• B. Fluid overload
• C. Hypocalcemia
• D. Graft-versus-host disease

Answer 1

The Correct Option is B

The patient was transfused with 4 units of blood, which can potentially lead to a rapid increase in blood volume. The symptoms she is experiencing—chest discomfort and bilateral fissural thickening shown in the X-ray—are indicative of pulmonary complications. Among the options provided, fluid overload is a likely cause as it commonly results in pulmonary symptoms like these due to excessive intravascular volume and subsequent leakage into the lungs.
Here's a breakdown of why fluid overload is the most probable cause:

• Fluid overload, or transfusion-associated circulatory overload (TACO), occurs when the volume of transfused blood exceeds the patient's circulatory capacity, leading to heart and lung strain.
• It often presents with respiratory distress, increased JVP (Jugular Venous Pressure), and signs of pulmonary edema, such as bilateral fissural thickening on chest X-ray.
• ABO incompatibility reactions typically present with fever, back pain, hemoglobinuria, and shock, not predominantly respiratory symptoms.
• Hypocalcemia due to citrate in transfused blood would more commonly cause tetany, muscle cramps, or parasthesia, not bilateral fissural thickening.
• Graft-versus-host disease (GVHD) is a delayed reaction occurring weeks to months post-transfusion, presenting with skin rash, liver dysfunction, and gastrointestinal symptoms.

Given these facts, fluid overload matches the symptomatology and timeline associated with the presented clinical scenario.