Differential Diagnosis for Unconscious and Comatose Patient after Blood Transfusion through Central Venous Line (CVL)

• Single most likely diagnosis:
  • Air embolism: The administration of blood products through a central venous line can lead to air embolism if the line is not properly flushed or if there is a breach in the line, allowing air to enter the circulation. This is a rapid and potentially fatal complication.
• Other Likely diagnoses:
  • Circulatory overload: Transfusion of blood products can lead to volume overload, especially in patients with cardiovascular compromise, leading to symptoms such as respiratory distress and potentially progressing to unconsciousness.
  • Transfusion-related acute lung injury (TRALI): A serious complication of blood transfusion characterized by non-cardiogenic pulmonary edema, which can lead to respiratory failure and potentially affect the patient's level of consciousness.
  • Anaphylactic reaction: Although less common, anaphylactic reactions to blood products can occur and may present with symptoms ranging from mild to severe, including loss of consciousness.
• Do Not Miss diagnoses:
  • Septic shock (d): While less likely given the context, septic shock from contaminated blood products is a potentially fatal condition that must be considered, especially if the patient shows signs of infection or sepsis.
  • Wrong cross-match (e): A hemolytic transfusion reaction due to ABO incompatibility is a medical emergency that can lead to severe symptoms, including renal failure, shock, and death. It's crucial to rule out this possibility, especially given the severity of the patient's condition.
• Rare diagnoses:
  • Late complication of blood transfusion (a): While late complications such as iron overload or transfusion-associated graft-versus-host disease can occur, they are unlikely to present with acute unconsciousness and coma.
  • Electrolytes imbalance (b) and Hyponatremia (c): These conditions can occur due to various reasons, including the transfusion itself or the underlying condition requiring transfusion. However, they are less directly linked to the act of transfusing blood through a CVL compared to other options listed.