A fictional 64-year-old develops rigors, fever, back pain and hypotension fifteen minutes after a red-cell transfusion begins.
Listen for the assumption.
I planned to slow the transfusion and give paracetamol because fever can be a minor reaction.
Which features make that unsafe?
Hypotension, pain and systemic symptoms raise concern for a severe reaction, incompatibility or contamination. The transfusion must be stopped and the patient assessed immediately.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- The bedside identity check reveals a discrepancy
- Urine becomes dark
- The blood component and administration set remain available
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
I will treat shock, recheck identity and compatibility, and consider haemolysis, bacterial contamination, anaphylaxis, TRALI and TACO.
Correct. Send protocol investigations, monitor urine output and coagulation, and ensure haemovigilance reporting after immediate care.
I will document the component, start and reaction times, observations, identity check, actions and laboratory advice.
What must remain explicit.
- Stop the transfusion immediately for a suspected severe reaction.
- Maintain venous access and resuscitate according to the clinical syndrome.
- Do not discard the implicated component or giving set.
Where reasoning fails.
- Slowing rather than stopping
- Assuming all fever is a minor febrile reaction
- Discarding the component before investigation
Severe suspected transfusion reaction during component [details], started [time], symptoms/observations [trend], identity check [result], transfusion stopped [time], resuscitation [response] and laboratory advice [status].
Where are your local transfusion-reaction forms, sampling instructions and emergency contact numbers kept?