A nurse is caring for a client who is receiving a unit of packed red blood cells. Fifteen minutes following the start of the transfusion, the nurse notes that the client is febrile, with chills and red-tinged urine. Which of the following transfusion reactions should the nurse suspect?

Rationale: A. Febrile non-hemolytic transfusion reactions are the most common type of reaction. They typically present with fever, chills, and sometimes mild hypotension, usually occurring within 1–6 hours of starting the transfusion. These reactions are caused by antibodies directed against donor leukocytes or cytokines in the blood product. However, they do not cause hematuria or red-tinged urine, which is a key sign of more severe transfusion reactions. While febrile reactions can cause discomfort, they are generally not life-threatening. B. The client’s symptoms of fever, chills, and red-tinged urine (hemoglobinuria) within minutes of starting the transfusion indicate an acute hemolytic transfusion reaction (AHTR). This reaction usually results from ABO incompatibility, where the recipient’s antibodies attack the donor red blood cells. It is a medical emergency because it can rapidly progress to hypotension, disseminated intravascular coagulation (DIC), acute kidney injury, and shock. Other signs may include flank or back pain, tachycardia, and dark-colored urine. Immediate nursing actions include stopping the transfusion, maintaining IV access with normal saline, monitoring vital signs, notifying the provider, sending blood and urine samples for testing, and preparing for emergency interventions. C. Acute pain transfusion reactions are rare and usually occur in patients with sickle cell disease or multiple transfusions, characterized by severe back or chest pain during the transfusion. They are not associated with hematuria, chills, or fever, so this presentation does not match. D. Allergic transfusion reactions are caused by antibodies to plasma proteins in donor blood and are typically mild. Symptoms include urticaria, itching, flushing, and sometimes wheezing. Severe allergic reactions can progress to anaphylaxis, but they do not cause hematuria or fever with chills.