List two absolute contraindications to performing MLD.

• A. Acute infection with fever; active DVT or pulmonary embolism.
• B. Controlled hypertension and stable GERD.
• C. Allergic rhinitis and mild dehydration.
• D. Recent vaccination and seasonal flu.

Answer: (A)

When deciding about manual lymph drainage, treat conditions that pose direct risk to the patient as absolute contraindications. An acute infection with fever signals systemic illness, so performing MLD could worsen the body’s stress response and isn’t appropriate until the infection has resolved. An active deep vein thrombosis or pulmonary embolism is a serious risk because even light limb manipulation could potentially dislodge a clot or worsen circulation, leading to a life-threatening event.

Other scenarios listed do not pose the same immediate safety risk. Controlled hypertension and stable GERD are not absolute barriers to treatment (they may require clinical judgment). Allergic rhinitis and mild dehydration aren’t absolute contraindications—the latter may need assessment, but mild dehydration doesn’t automatically prevent MLD. Recent vaccination or seasonal flu likewise isn’t an automatic barrier.