Under general anaesthesia for emergency laparotomy, a patient receives 2 units of packed red cells crossmatched against an outdated sample. Twenty minutes later the anaesthetist notes sudden hypotension, tachycardia, generalized ooze from the surgical field, and dark red urine. The transfusion should be stopped and the priority next step is:

• A Send the unit and patient sample to confirm haemolysis and start aggressive crystalloid to protect renal perfusion ✓
• B Give intravenous furosemide to maintain urine output
• C Administer intravenous hydrocortisone and chlorpheniramine and continue the transfusion slowly
• D Start a heparin infusion to treat disseminated intravascular coagulation

Explanation

This is an acute haemolytic transfusion reaction, usually from ABO incompatibility due to clerical error. Under anaesthesia the classic signs of fever, loin pain, and agitation are masked, leaving hypotension, haemoglobinuria, and DIC-type ooze as clues. The mandatory steps are stopping the transfusion, returning the unit and a fresh patient sample for repeat grouping and Coombs testing, and vigorous isotonic fluid to maintain urine output and prevent ATN. Antihistamines and steroids are for mild allergic reactions, and heparin is not routine here.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.