What is the most common cause of mortality associated with blood transfusion?

What is the most common cause of mortality associated with blood transfusion?

• A. ABO hemolytic transfusion reaction
• B. Non-ABO hemolytic transfusion reaction
• C. Microbial infection
• D. Transfusion-related acute lung injury (TRALI)

Answer: (D)

Transfusion-related mortality most often comes from transfusion-related acute lung injury, a rapid, noncardiogenic pulmonary edema that happens within hours of a transfusion. The problem starts when donor plasma contains antibodies or other mediators that trigger inflammation in the recipient’s lung vessels, causing capillary leak and fluid accumulation in the lungs. Clinically, this presents as sudden shortness of breath, low oxygen levels, and diffuse infiltrates on chest imaging, often with hypotension. The key management step is to stop the transfusion and provide supportive care, including oxygen and, if needed, ventilatory support, while distinguishing TRALI from other causes of pulmonary edema like transfusion-associated circulatory overload. Why this is the best answer: while other transfusion-related complications can be serious, they occur less frequently or are less lethal in modern practice due to rigorous pretransfusion testing and product safety measures. ABO incompatibility is extremely rare thanks to crossmatching; non-ABO hemolytic reactions can cause morbidity but have a lower mortality burden; septic transfusion reactions do occur but are less common with current screening. TRALI carries a higher mortality risk per event and has historically been the leading cause of transfusion-related death.

Transfusion-related mortality most often comes from transfusion-related acute lung injury, a rapid, noncardiogenic pulmonary edema that happens within hours of a transfusion. The problem starts when donor plasma contains antibodies or other mediators that trigger inflammation in the recipient’s lung vessels, causing capillary leak and fluid accumulation in the lungs. Clinically, this presents as sudden shortness of breath, low oxygen levels, and diffuse infiltrates on chest imaging, often with hypotension. The key management step is to stop the transfusion and provide supportive care, including oxygen and, if needed, ventilatory support, while distinguishing TRALI from other causes of pulmonary edema like transfusion-associated circulatory overload.

Why this is the best answer: while other transfusion-related complications can be serious, they occur less frequently or are less lethal in modern practice due to rigorous pretransfusion testing and product safety measures. ABO incompatibility is extremely rare thanks to crossmatching; non-ABO hemolytic reactions can cause morbidity but have a lower mortality burden; septic transfusion reactions do occur but are less common with current screening. TRALI carries a higher mortality risk per event and has historically been the leading cause of transfusion-related death.