When a febrile transfusion reaction is suspected, what is the first step in management?

• A. Stop the transfusion and obtain labs such as CBC, haptoglobin, and LDH
• B. Continue the transfusion with antipyretics
• C. Initiate broad-spectrum antibiotics
• D. Check blood bank records for issues

Answer: (A)

When a febrile transfusion reaction is suspected, the immediate priority is to stop the transfusion to prevent further exposure and potential worsening of the reaction. After stopping, obtain labs to assess for hemolysis and to guide next steps: a CBC to evaluate the level of anemia, LDH and bilirubin to reflect tissue breakdown, and haptoglobin, which decreases when intravascular hemolysis is occurring. These tests help distinguish between a febrile nonhemolytic reaction and a more dangerous acute hemolytic reaction, and they inform whether additional interventions are needed. Keep IV access with normal saline, monitor the patient closely, and contact transfusion medicine for further evaluation. Continuing the transfusion or giving antibiotics or merely checking bank records would not address the immediate need to identify and halt a potential transfusion reaction.