MBBS OSCE · General Medicine
OSCE — Transfusion Medicine & Transfusion Reactions
Eight-minute OSCE station on Transfusion Medicine & Transfusion Reactions: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Transfusion Medicine & Transfusion Reactions.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Blood transfusion is a liquid transplant: each unit places donor cells, plasma proteins and donor leucocyte-fragments into a recipient, with benefits (oxygen carriage, haemostasis, volume) balanced against immune, infectious, and circulatory risks. The two universal safety principles are correct ABO/Rh matching (the commonest fatal error is clerical mislabelling of a sample or unit) and a restrictive transfusion strategy — red-cell threshold haemoglobin under 70 g/L (under 80 g/L in cardiac surgery, symptomatic anaemia, or active bleeding), one unit then reassess. Components: PRBCs (anaemia/haemorrhage), platelets (thrombocytopenia, prophylaxis under 10 x 10^9/L), fresh frozen plasma (INR ov
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Fever, flank/back pain, hypotension and haemoglobinuria early in a transfusion — |
| Safety | Acute dyspnoea with bilateral infiltrates within 6 h of transfusion — TRALI (or |
| Safety | Anaphylaxis (bronchospasm, hypotension, stridor) during transfusion — IgA defici |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.