A M

Fellow Internal Medicine

Pluviophile

[Itebimien Peter @PeterItebimien]

You are dealing with two separate, concurrent transfusion reactions: An Allergic Reaction and a Febrile Non-Hemolytic Transfusion Reaction (FNHTR).
Because both are non-hemolytic in nature, the crossmatch from the contralateral arm will return as compatible.

Here is exactly what happened:

1. The Fever and Chills/Rigors: Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

The patient’s immune system is reacting to residual white blood cells (leukocytes) or cytokines accumulated in the donor blood bag during storage.
Why the crossmatch is compatible

The red blood cells (RBCs) themselves are perfectly matched. The issue is with the donor's white blood cells, which the standard pre-transfusion crossmatch (which primarily tests RBC compatibility) doesn't prevent.

How it presents:
Often presents towards the end of the transfusion, or shortly after, with a temperature increase of > 1°C, accompanied by shaking chills and rigors.

2. The Urticarial Rash: Allergic Reaction

What it is: A hypersensitivity reaction where the recipient's immune system reacts to soluble plasma proteins or allergens present in the donor's blood product.
Why the crossmatch is compatible

Like FNHTRs, mild allergic reactions are driven by plasma components, not an ABO or minor antigen mismatch on the RBCs themselves.

How it presents:
Localized or generalized hives, pruritus (itching), and redness.

What You Should Do Next

Stop the transfusion immediately. Do not restart the unit.

Support the patient: Keep the intravenous (IV) line open with normal saline.

Administer medications:
Provide an antipyretic (e.g., paracetamol) for the fever and an antihistamine (e.g., diphenhydramine) for the urticarial rash.

Notify the blood bank: Inform them of the clinical presentation so they can document the reaction and implement preventative measures (e.g., leukoreduced or washed blood products) for future transfusions.

[A M @AMInternist1992]

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[A M @AMInternist1992]

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[A M @AMInternist1992]

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[A M @AMInternist1992]

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[A M @AMInternist1992]

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[A M @AMInternist1992]

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[A M @AMInternist1992]

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[A M @AMInternist1992]

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[Ahmed Elaskari @guidelinesMed]

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[A M @AMInternist1992]

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[Ahmed Elaskari @guidelinesMed]

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Diagnosis?

[A M @AMInternist1992]

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How to differentiate between incomplete Right bundle branch block(or other Brugada phenocopies) and type 2 Brugada syndrome?

1-Beta angel more than 58 indicates Brugada
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2-The base of the triangle 4 mm or more indicates Brugada syndrome