What should be the first action if a client develops hives during a transfusion?

• A. Continue transfusion at slower rate
• B. Document reaction and continue
• C. Stop transfusion and notify provider
• D. Treat with antihistamine and continue

Answer: (C)

Recognize that hives during a transfusion signal an allergic transfusion reaction, and the top priority is patient safety. The first step is to stop the transfusion immediately to stop further exposure to the donor blood and prevent the reaction from getting worse. After stopping, keep the IV line open with normal saline, assess the patient’s airway, breathing, and circulation, and notify the provider so they can issue the appropriate orders (which may include antihistamines, steroids, or other interventions and guidance on whether to resume a transfusion or switch products). Document the reaction and the actions taken.

Continuing the transfusion at a slower rate would still expose the patient to the allergen, which can escalate the reaction. Simply documenting and continuing, or treating with an antihistamine and then proceeding, delays potentially life-saving management and is not appropriate as the initial response.