A platelet concentrate should be ordered for the patient as the bleeding is likely due to the thrombocytopenia. Additional investigations to determine the cause of thrombocytopenia should be ordered after the epistaxis has resolved so recommendations for further management can be made. In addition, the patient's vital signs should be monitored and the hemoglobin level should be checked given the extent of blood loss. If the patient's blood loss is sufficient to warrant replacement, the physician should consider a red cell concentrate for the patient.

It is important to go see the patient to clinically assess the severity and extent of the possible transfusion reaction. Given this clinical picture, it is possible that the patient is suffering from a TRALI. The transfusion should be stopped, the IV line left open with normal saline, a chest x-ray ordered and the blood bank notified. Supportive care including oxygenation and mechanical ventilation should be considered, depending on the situation.