Differential Diagnosis for Itching and Hives during Transfusion in a 69-year-old with Myelodysplastic Syndrome
- Single most likely diagnosis
- Allergic reaction to transfused blood components: This is the most common cause of itching and hives during a blood transfusion. The patient's immune system may react to proteins or other substances in the donated blood, leading to an allergic response.
- Other Likely diagnoses
- Transfusion-related acute lung injury (TRALI): Although TRALI typically presents with respiratory symptoms, some patients may experience urticaria (hives) as part of the reaction. The patient's myelodysplastic syndrome may increase the risk of TRALI.
- Anaphylactoid reaction: Similar to an allergic reaction, an anaphylactoid reaction can occur during a transfusion, causing symptoms such as itching, hives, and potentially life-threatening anaphylaxis.
- Do Not Miss diagnoses
- Anaphylaxis: A severe, life-threatening allergic reaction that requires immediate medical attention. Although less common, anaphylaxis can occur during a transfusion and is critical to recognize and treat promptly.
- Hemolytic transfusion reaction: Although typically associated with more severe symptoms like jaundice and hemoglobinuria, a hemolytic transfusion reaction can occasionally present with urticaria. This diagnosis is critical to consider due to its potential severity.
- Rare diagnoses
- Transfusion-associated circulatory overload (TACO): While TACO is more commonly associated with respiratory and cardiovascular symptoms, some patients may experience urticaria as part of the reaction.
- IgA deficiency with anti-IgA antibodies: This rare condition can cause an allergic reaction during a transfusion, including symptoms like itching and hives. However, this diagnosis is less likely and would require specific testing to confirm.