During a blood transfusion, a patient develops itching, hives, and shortness of breath; what should you do first?

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Stopping the transfusion is the immediate priority because any suspected transfusion reaction requires halting donor blood exposure to prevent further worsening of symptoms and possible life-threatening airway or circulatory problems. The itching and hives point to an allergic reaction, and shortness of breath raises concern for airway involvement or anaphylaxis, so cutting off the infusion stops additional antigen exposure and buys time to secure the patient's breathing and circulation. After stopping the transfusion, you should support ABCs—assess airway, give oxygen if needed, start IV fluids, and monitor vital signs, while contacting the blood bank and the treating team. Treatments like epinephrine are reserved for more severe reactions or clear anaphylaxis, antihistamines such as diphenhydramine can help with mild allergic symptoms, and a diuretic would not address a transfusion reaction and is not appropriate.