What is the immediate management for an anaphylactic or acute hemolysis transfusion reaction?

• A. Continue transfusion and give diphenhydramine
• B. Stop transfusion and give epinephrine IM
• C. Stop transfusion, start normal saline or lactated Ringer's; give diphenhydramine IM or slow IV
• D. Administer antibiotics

Answer: (C)

The immediate goal is to stop further exposure and support the patient’s circulation while addressing the reaction’s histamine-mediated symptoms.

Stop the transfusion at once to prevent more antigen exposure. Secure the airway and breathing as needed, and establish IV access. Begin a crystalloid fluid bolus with normal saline or lactated Ringer’s to maintain perfusion and urine output in case of hypotension. Administer diphenhydramine IM (or slow IV) to counter histamine release and its effects. In a true anaphylactic scenario, epinephrine would be added if symptoms indicate progressing or severe anaphylaxis, but the essential first steps here are stopping the transfusion, fluids, and an antihistamine to stabilize the patient. Antibiotics do not address the immediate reaction, and continuing the transfusion would worsen the situation.