Which of the following is a sign & symptom of a haemolytic reaction to blood transfusion?

Appeared in: NHM UP Staff Nurse - 2016

Explanation

Hemoglobinuria is the hallmark sign of an acute hemolytic transfusion reaction (AHTR).
It occurs when incompatible red blood cells are destroyed (intravascular hemolysis), releasing free hemoglobin into the plasma.
This free hemoglobin is then filtered by the kidneys and excreted in the urine, causing it to appear dark red or cola-colored.
Other classic signs of AHTR include fever, chills, low back pain, and hypotension.

Option B: Chest pain is a non-specific symptom. While it can occur in a hemolytic reaction, it is not a defining sign.
Option C: Urticaria, or hives, is the classic sign of a mild allergic reaction to a blood transfusion, not a hemolytic reaction.
Option D: Distended neck veins are a key indicator of fluid volume overload, not hemolysis.

Clinical Relevance

Nursing practice connection: Knowing Recognition of signs and symptoms of an acute hemolytic transfusion reaction helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Immediate recognition of an acute hemolytic reaction is critical to patient survival. The nurse's first action must always be to stop the transfusion.
Failure to stop the transfusion can lead to severe complications, including disseminated intravascular coagulation (DIC), acute kidney injury, shock, and death.
What if? If the patient develops hives and itching but has no fever, back pain, or changes in vital signs, the nurse should suspect a mild allergic reaction. The provider may order an antihistamine, and the transfusion might be resumed slowly with close observation, unlike the immediate cessation required for a hemolytic reaction.

How to Approach the Question

First, identify the keywords in the question: 'haemolytic reaction' and 'sign & symptom'.
This is a knowledge-based question requiring you to recall the specific manifestations of different transfusion reactions.
Mentally review the pathophysiology of a hemolytic reaction: incompatible blood leads to RBC destruction (hemolysis), which releases hemoglobin.
Consider how the body processes excess free hemoglobin. The kidneys excrete it, leading to hemoglobin in the urine (hemoglobinuria).
Evaluate each option: Urticaria points to an allergic reaction. Distended neck veins point to fluid overload (TACO). Chest pain is non-specific. Hemoglobinuria is the direct result of intravascular hemolysis.
Select the option that is most specific and directly linked to the pathophysiology of a hemolytic reaction.

Concept Tested & Keywords

Concept Tested: Recognition of signs and symptoms of an acute hemolytic transfusion reaction.
Stem keywords: haemolytic reaction, blood transfusion, sign & symptom
Lead-in keywords: Which of the following

Qs4AVKFF285-FXnKvRAs4Z

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 124-126

E6 Gynecology Williams p. 8-30

Practise the full NHM UP Staff Nurse - 2016

Attempt every question from this paper in a timed mock, then review the full solution for each one.