Common signs of a transfusion reaction to monitor for intraoperatively?

• A. Fever with no other symptoms.
• B. Hypotension and back pain only.
• C. Hemoglobinuria without other signs.
• D. Fever, hypotension, flank or back pain, hemoglobinuria, chills.

Answer: (D)

Transfusion reactions during surgery tend to present with a cluster of signs that reflect different aspects of the reaction, not just one symptom. The combination of fever, hypotension, flank or back pain, hemoglobinuria, and chills captures the main ways the body responds: fever and chills from the immune or cytokine response; hypotension from vasodilation and potential shock; flank or back pain due to renal capsule irritation from intravascular hemolysis; and hemoglobinuria signaling that red cells are being destroyed and free hemoglobin is filtered into the urine. When these signs appear together, they strongly point to an acute transfusion reaction and warrant prompt action.

Relying on a single sign, like fever alone, or hypotension with back pain alone, can miss other important features and delay recognition. Hemoglobinuria without other signs is not as reliable for diagnosing a transfusion reaction in the intraoperative setting because it may occur in other contexts, and isolating one symptom doesn’t convey the full clinical picture. The most complete and reliable pattern is the full spectrum of signs listed.