Which actions are recommended immediately when a transfusion reaction is suspected?

• A. Stop the infusion; start normal saline bolus; keep IV tubing and the blood unit for testing
• B. Increase the transfusion rate; reassess later
• C. Administer a diuretic
• D. Discard the blood unit and continue transfusion with no changes

Answer: (A)

When a transfusion reaction is suspected, the priority is to stop exposing the patient to the blood product while preserving evidence and supporting circulation. Stopping the transfusion immediately prevents ongoing exposure to the possible offending antigen or contaminant, which can rapidly worsen a reaction. After stopping, flush the IV line with normal saline to maintain venous access and ensure adequate circulating volume, especially if the patient is showing signs of instability such as hypotension or tachycardia. Keeping the IV tubing and the remaining blood product intact allows the blood bank to perform the necessary testing to determine the cause of the reaction, verify labeling and compatibility, and identify any issues with the transfusion process. This approach also enables prompt communication with the treating team and facilitates further assessment, treatment, and documentation. Increasing the transfusion rate, giving a diuretic, or discarding the product and continuing without changes do not address the immediate need to stop exposure, support the patient, and preserve evidence for a critical investigation.