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Transfusion Reaction Management — FRCA Final MCQ

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EasyAnaesthetic Equipment & SafetyTransfusion Reaction ManagementFRCA Final

A 42-year-old woman develops rigors and a temperature of 39.5°C, increased from 36.8°C, 20 minutes after a packed red cell transfusion is started. Her heart rate is 105 min−1, blood pressure 110/70 mmHg and SpO2 98% on air. She has no rash, wheeze or ongoing haemorrhage. What is the most appropriate immediate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Stop the transfusion, maintain venous access and notify the transfusion laboratory

This is a moderate acute febrile transfusion reaction: the temperature is at least 39°C, has risen by more than 2°C and is accompanied by rigors. Stop the transfusion, maintain venous access with a new administration set, assess the patient, recheck patient–component identification and notify the transfusion laboratory. Bacterial contamination and acute haemolysis must be excluded; the implicated unit and giving set should be retained, with patient samples sent for repeat compatibility testing, haemolysis investigations and cultures. Slowing or restarting the unit with paracetamol is reserved for carefully assessed mild isolated reactions, not this presentation. Adrenaline is indicated for anaphylaxis, for which there is no airway, respiratory, circulatory or mucocutaneous evidence. Chlorphenamine alone is appropriate only for a mild allergic reaction and does not address high fever with rigors.

Reference: British Society for Haematology, Guideline on the Investigation and Management of Acute Transfusion Reactions: Summary of Key Recommendations, Immediate Management and Diagnostic Investigations, 2023. https://bhnog.wales.nhs.uk/wp-content/uploads/2023/12/BSH_InvestigationManagement-of-ATR_2023_BHNOG-summary.pdf