What is an immediate action if an acute hemolytic transfusion reaction is suspected?

• A. Increase IV rate.
• B. Stop transfusion, maintain IV with saline, notify physician and blood bank.
• C. Continue transfusion.
• D. Administer epinephrine.

Answer: (B)

A suspected acute hemolytic transfusion reaction is a medical emergency, and the priority is to halt further harm from the incompatible donor cells. Stop the transfusion immediately, keep the IV line open with normal saline to maintain perfusion and help dilute circulating free hemoglobin, and promptly notify the physician and the blood bank for rapid investigation and action. Continuing or increasing the transfusion would feed the ongoing destruction of red cells and worsen kidney injury, so neither option is appropriate. Epinephrine is not routinely used for this situation; it’s reserved for anaphylactic-type reactions, which are a different transfusion reaction. After stopping the transfusion, subsequent steps focus on supportive care, monitoring, and diagnostic workup as directed by the team.