A patient received about 15 mL of compatible blood and developed severe shock, but no fever. What kind of red blood cell component should be given for the next transfusion?

In this scenario, where a patient has experienced severe shock after receiving compatible blood without developing a fever, it suggests a potential acute reaction that is not purely due to an immune response related to an incompatible blood type. The absence of fever indicates that a febrile reaction, which typically prompts the use of leukocyte-reduced products, is less likely.

Choosing washed red blood cells is appropriate in this case because washing removes plasma proteins, antibodies, and other potential mediators of transfusion reactions, which can help prevent further adverse reactions such as an anaphylactic response or allergic reactions. If a patient has had a severe reaction to a small volume of transfused blood, the concern for additional reactions increases, making washed red blood cells a safer option for the next transfusion to mitigate further risks.

Leukocyte-reduced red blood cells are also a common choice to minimize febrile non-hemolytic transfusion reactions, but in cases where a severe reaction has already occurred, using washed red blood cells removes a broader array of potential contaminants. This makes it a more cautious approach in managing patients with known sensitivity, thereby increasing safety in transfusion practices.