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Febrile transfusion reaction — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesFebrile transfusion reactionSCE Acute Medicine

A 64-year-old woman is assessed on the acute medical unit. She develops fever, rigors and back pain 20 minutes into a red-cell transfusion. Blood pressure is falling and the blood unit is still attached. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most important immediate action?

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Correct answer: D — Stop the transfusion and assess ABCDE

Stop the transfusion and assess ABCDE is the best answer because an acute transfusion reaction requires immediate cessation and clinical assessment while preserving the line with saline. Activate the major haemorrhage protocol is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Clerical checks and blood bank notification follow initial stabilisation.

Reference: https://b-s-h.org.uk/guidelines#acute-medicine-order-100-1