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Congenital long QT syndrome
48%
23/48
COPD
6%
3/48
Heart failure
12%
6/48
IgA deficiency
19%
9/48
Persistent intraabdominal bleeding
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This patient experienced sudden wheezing and worsening hypotension while receiving a transfusion which is concerning for anaphylaxis. Patients with IgA deficiency are predisposed to this reaction. The most common adverse reactions to blood transfusions are fever, chills, and urticaria. Although less common, a more serious adverse reaction to blood transfusions is an acute hemolytic reaction due to ABO incompatibility or a septic reaction due to bacterial contamination of blood. A less common reaction that may lead to anaphylaxis may result from exposure to IgA in a patient who is naturally deficient in IgA. Key presenting symptoms of anaphylaxis include hypotension, wheezing, and swelling of the upper airway. Blood products that contain IgA (such as whole blood) are the usual culprit. The management of anaphylaxis is to promptly stop the transfusion and administer epinephrine. Other historical features that may be seen in IgA deficiency include repeat GU/GI infections and upper respiratory infections. Incorrect Answers: Answer 1: Congenital long QT syndrome such as Romano-Ward syndrome or Jervell and Lange-Nielsen syndrome (also has sensorineural deafness) could predispose a patient to torsades des pointes and cardiac arrest; however, it would be unlikely for this patient to also have this condition and it be the etiology of his symptoms given he is having clear findings concerning for anaphylaxis. Answer 2: COPD presents with wheezing and a barrel chest in a long-term smoker. It is possible that this patient has COPD given his history of smoking; however, it is unlikely that his sudden onset wheezing is secondary to COPD when compared to anaphylaxis given the sudden onset of symptoms and hypotension. Answer 3: Heart failure can present with hypotension and wheezing but likely would not occur suddenly during a transfusion. It is true that giving the patient a large amount of fluids/volume could cause a heart failure exacerbation; however, symptoms would not be so sudden and in a patient who is hypotensive (thus, they are volume down and not fluid overloaded). Answer 5: Persistent intraabdominal bleeding may contribute to this patient's unstable vitals; however, it does not explain the sudden worsening of hypotension and wheezing during a transfusion. Bullet Summary: Patients with IgA deficiency who receive a transfusion with blood products that contain IgA can experience anaphylaxis.
4.6
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