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Reactions to platelet transfusion are common and range from mild temperatures to rigors. The development of an urticarial rash is also frequently seen. When a transfusion reaction develops, the following steps should be taken:

^ Stop the transfusion.

^ Give 10mg chlorphenamine (chlorpheniramine) IV and 1g of paracetamol PO.

^ Cover future transfusions with chlorpheniramine and paracetamol 30 mins pre-transfusion.

• Hydrocortisone 100mg IV stat may be (sparingly) used for refractory reactions

• Pethidine is a suitable alternative for severe reactions and is almost invariably effective. Give 25mg IV stat with repeat dose if necessary or set up an IVI of 25-50mg IV over 8h.

• The possibility of generation of HLA and platelet-specific antibodies should also be considered (see below).

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