A 65-year-old patient receiving packed red blood cells for postoperative anaemia develops sudden hypotension, bronchospasm, and generalised urticaria within 15 minutes of starting the transfusion. What is the immediate first-line management?

• A Intramuscular adrenaline 0.5 mg (1:1000) ✓
• B Intravenous hydrocortisone and chlorpheniramine
• C Intravenous normal saline bolus 500 mL
• D Subcutaneous adrenaline 0.3 mg (1:1000)

Explanation

This is anaphylactic transfusion reaction, a life-threatening emergency. Intramuscular adrenaline 0.5 mg of 1:1000 solution into the anterolateral thigh is the first-line treatment. The transfusion must be stopped immediately. Antihistamines and steroids are adjuncts but do not replace adrenaline as first-line therapy.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.