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Paeds Vivashaematology-oncology-and-transfusion

Paeds Vivas · haematology-oncology-and-transfusion

Transfusion reactions and massive transfusion: Viva

Branching clinical structured oral on transfusion reactions and massive transfusion in children, covering the stop-the-transfusion rule, the bedside distinction of TACO from TRALI, the mechanism and management of the acute haemolytic reaction, and the paediatric massive transfusion protocol, appraising the paediatric epidemiology of Stone and Wang, the haemolytic review of Panch, the Lancet series of Delaney and the TACO and TRALI reviews of Semple, Bosboom, Tung and Yu.

branching clinical structured oral2 min readVerification in progress

Target exams

RACP DWERACP DCEMRCPCH Clinical
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Target exams

RACP DWERACP DCEMRCPCH Clinical
Prompt
A six-year-old boy on the oncology ward develops fever, rigors and flank pain five minutes into a unit of packed red cells, with a fall in blood pressure and dark urine. The examiner asks you to describe the immediate management, the mechanism of the acute haemolytic reaction, the investigation that confirms it, the bedside distinction of TACO from TRALI in a breathless child after transfusion, and the principles of the paediatric massive transfusion protocol.

Opening question

The candidate is expected to start with the stop-the-transfusion rule. The first response to any suspected acute transfusion reaction is to stop the transfusion at once, keep the intravenous line open with normal saline, check the airway, the breathing and the circulation, verify the identity of the child and the unit at the bedside, and return the unit and the fresh samples to the blood bank. The candidate who states that the rule is the same for the mild fever and the haemolytic crisis, because the mild reaction cannot be told from the severe one in the first minutes, has the discipline that the topic rewards. [4]

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References6ShowHide
  1. [1]Stone EF, Chacreton D, Jimenez A, et al Epidemiology of pediatric transfusion reactions. JAMA Netw Open, 2026.PMID 42043816
  2. [3]Panch SR, Montemayor-Garcia C, Klein HG Hemolytic transfusion reactions. N Engl J Med, 2019.PMID 31291517
  3. [4]Delaney M, Wendel S, Bercovitz RS, et al Transfusion reactions: prevention, diagnosis, and treatment. Lancet, 2016.PMID 27083327
  4. [5]Semple JW, Rebetz J, Kapur R Transfusion-associated circulatory overload and transfusion-related acute lung injury. Blood, 2019.PMID 30808638
  5. [8]Bosboom JJ, Klanderman RB, Migdady Y, et al Transfusion-associated circulatory overload: a clinical perspective. Transfus Med Rev, 2019.PMID 30853167
  6. [9]Neff LP, Beckwith MA, Russell RT, et al Massive transfusion in pediatric patients. Clin Lab Med, 2021.PMID 33494884
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