A patient in the surgical ICU develops acute haemolytic transfusion reaction 30 minutes after starting a blood transfusion. He develops fever, rigors, flank pain, and haemoglobinuria. What is the MOST critical immediate step?
- A Give antipyretics and continue transfusion at a slower rate
- B Stop transfusion immediately, maintain IV access with normal saline, send blood samples and bag to blood bank ✓
- C Give corticosteroids and antihistamines to suppress immune reaction
- D Perform plasmapheresis to remove antibody-coated red cells
Correct answer: B. Stop transfusion immediately, maintain IV access with normal saline, send blood samples and bag to blood bank
Explanation
Acute haemolytic transfusion reaction (most often due to ABO incompatibility) is life-threatening and requires immediate cessation of the transfusion to minimise further antigen-antibody complex formation and haemolysis. IV access should be maintained with 0.9% saline for fluid support and to maintain renal perfusion. The blood unit and patient samples (pre- and post-transfusion) must be sent to the blood bank urgently for analysis. Management also includes monitoring urine output, treating DIC if it develops, and supportive care.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.