What is the priority action for a transfusion reaction with fever, chills, and flank pain?

• A. Stop transfusion and notify provider.
• B. Continue transfusion and notify provider later.
• C. Administer analgesia only.
• D. Obtain a urine culture.

Answer: (A)

The priority action is to stop the transfusion immediately. Signs like fever, chills, and flank pain strongly suggest an acute hemolytic transfusion reaction, which can rapidly cause life-threatening intravascular hemolysis, shock, and kidney injury if not halted right away. After stopping the transfusion, keep IV access open with normal saline, notify the provider and the blood bank, and send the blood product and tubing to the lab for investigation while you assess the patient’s vitals, monitor urine for hemoglobinuria, and begin supportive care as needed. Analgesia alone won’t stop the immune reaction, and continuing the transfusion or delaying notification could worsen the outcome; a urine culture wouldn’t address the immediate reaction either.