During transfusion for a lower GI bleed, hand spasm occurs when cuff inflates; you should consider:

• A. Stop transfusion
• B. Administer potassium
• C. Calcium administration
• D. Administer diuretic

Answer: (C)

Hand spasm with cuff inflation is a classic sign of acute hypocalcemia from citrate toxicity during transfusion. Stored blood uses citrate as an anticoagulant; as it is transfused, citrate can bind ionized calcium in the patient, dropping calcium levels and causing neuromuscular irritability. Reversing this by administering calcium IV restores ionized calcium quickly and resolves the spasm, making calcium replacement the correct immediate intervention. Calcium gluconate is the usual agent, given carefully with monitoring, while transfusion can often continue with calcium on board. Other options don’t address the underlying hypocalcemia (potassium wouldn’t fix it; diuretics aren’t helpful here), and stopping transfusion isn’t the direct remedy to the acute symptom.