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A 36-year-old female is receiving a blood transfusion after having an abdominal hysterectomy. She has never had a blood transfusion previously. Both she and donor blood are type A+. As the first of two ordered units of packed red blood cells (PRBCs) is being infused, she develops fever and rigors. On exam, temperature is 37.9C (100.2F), pulse is 95 beats/minute, blood pressure is 122/68 mmHg, and oxygen saturation is 97% on room air. She appears diaphoretic. Lungs are clear with non-labored breathing. Abdominal exam is benign. There is yellow urine in her Foley catheter bag. Laboratory testing reveals hemoglobin of 6.5 g/dL, up from 6.0 g/dL postoperatively. Repeat blood type and crossmatch shows no incompatibility. What is the next best step in management for this patient? A. Use leukoreduced blood products for future transfusions B. Administer empiric broad-spectrum antibiotics C. Administer intramuscular (IM) epinephrine D. Give irradiated blood products for the next transfusion E. Give washed red blood cells for the next transfusion

Answer :

The next best step in management for this patient is to administer empiric broad-spectrum antibiotics.

Given the patient's symptoms of fever, rigors, diaphoresis, and elevated postoperative hemoglobin levels, it is likely that she is experiencing a transfusion reaction. Although initial testing did not show ABO incompatibility, this does not rule out other potential causes.

In this case, empiric broad-spectrum antibiotics should be administered to treat a potential transfusion-related infection.

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