Immediate management when transfusion reaction is suspected intraoperatively?

• A. Continue the transfusion.
• B. Increase IV fluids only.
• C. Administer antihistamines.
• D. Stop the transfusion immediately, start supportive care, and obtain samples for testing.

Answer: (D)

When a transfusion reaction is suspected during surgery, the priority is to stop the transfusion immediately and begin stabilization, while starting the workup to identify the cause. Halting the transfusion removes the ongoing exposure to the donor blood and its mediators, which can worsen hemolysis, anaphylaxis, or pulmonary injury. After stopping the infusion, focus on keeping the patient stable: ensure airway and breathing are supported, secure and maintain IV access with fresh fluids to preserve perfusion, and treat any emergent symptoms such as hypotension or bronchospasm as they arise.

Concurrently, obtain specimens for testing and alert the blood bank. Draw a post-reaction blood sample from the patient and keep the transfused blood bag and tubing for analysis. Provide the blood bank with details about the reaction and timing, and request a workup that typically includes tests for hemolysis and compatibility (such as direct antiglobulin testing and plasma-free hemoglobin) and appropriate testing of the donated product. Don’t restart the transfusion until the reaction type is identified and the patient is hemodynamically stable, ensuring ongoing safety and guiding future transfusion decisions.