Transfusion Medicine and Transfusion-Related Complications — WACS Viva & Clinical Scenarios (Haematology and Medical Oncology)

Exam-style transfusion medicine and transfusion-related complications viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 34-year-old multiparous woman with severe postpartum haemorrhage receives two units of uncrossmatched packed red blood cells. Fifteen minutes into the second unit, she develops sudden fever (39.2°C), severe flank pain, rigors, dyspnoea, hypotension (blood pressure 75/40 mmHg), and passage of dark red urine through her catheter. Detail your immediate bedside protocol, laboratory investigation algorithm, and emergency resuscitation strategy for suspected acute haemolytic transfusion reaction.
• SCENARIO 2: Contrast the pathophysiological mechanisms, clinical presentations, haemodynamic profiles, radiological findings, and specific therapeutic interventions of Transfusion-Related Acute Lung Injury (TRALI) versus Transfusion-Associated Circulatory Overload (TACO).
• SCENARIO 3: Outline the principles, activation criteria, component ratios, and laboratory-guided monitoring parameters of a Massive Transfusion Protocol (MTP) for catastrophic haemorrhage, detailing the prevention and correction of trauma-induced coagulopathy, metabolic acidosis, hypothermia, and citrate toxicity.
• SCENARIO 4: Explain the immunological principles, procedural steps, and clinical significance of ABO and Rhesus grouping, pre-transfusion compatibility cross-matching (immediate spin versus indirect antiglobulin phases), and irregular red cell antibody screening, including the approach to compatibility testing in patients with underlying warm autoimmune haemolytic anaemia.
• SCENARIO 5: Detail the clinical features, immunological mechanisms, diagnostic evaluation, and management of Delayed Haemolytic Transfusion Reactions (DHTR), Transfusion-Associated Graft-versus-Host Disease (TA-GvHD), Post-Transfusion Purpura (PTP), and chronic transfusion-induced haemosiderosis in sickle cell disease, incorporating institutional haemovigilance reporting workflows.