A patient develops pain at the transfusion site, chest tightness, and fever within minutes of starting a blood transfusion; what is the most likely diagnosis and how should it be managed?

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Acute Hemolytic Transfusion Reaction

This patient is experiencing an acute hemolytic transfusion reaction (AHTR), which represents a life-threatening medical emergency requiring immediate cessation of the transfusion. The clinical triad of pain at the IV site, chest tightness, and fever occurring within minutes of blood transfusion is pathognomonic for AHTR 1.

Why This is AHTR and Not the Other Options

The timing and symptom constellation definitively distinguish AHTR from other transfusion reactions:

  • Febrile non-hemolytic reaction presents with isolated fever and chills (incidence 1.1-2.15%) but critically lacks the characteristic pain at the IV site and does not cause acute respiratory distress or hemodynamic instability 1

  • Allergic reaction typically manifests with urticaria, pruritus, and skin flushing rather than IV site pain, and respiratory symptoms result from bronchospasm or laryngeal edema, not the acute dyspnea from systemic inflammation seen in AHTR 1

  • Bacterial contamination can present similarly but typically occurs within 6 hours after platelet transfusion specifically, and the immediate onset (within minutes) with the classic triad makes AHTR more likely 2, 3

Immediate Management Algorithm

Stop the transfusion immediately—this is the single most critical intervention that can prevent progression to severe morbidity or mortality 1, 4:

  1. Maintain IV access with normal saline for medication administration and fluid resuscitation 1

  2. Administer high-flow oxygen (high FiO₂) to address potential hypoxemia 4

  3. Monitor vital signs every 5-15 minutes, including heart rate, blood pressure, temperature, respiratory rate, and oxygen saturation 1, 4

  4. Maintain mean arterial pressure >65-70 mmHg with IV fluid resuscitation (normal saline bolus 1000-2000 mL) 1, 4

Critical Laboratory Workup

Send urgent laboratory studies immediately 1, 4:

  • Complete blood count
  • Direct antiglobulin test (Coombs test)
  • Repeat crossmatch
  • PT, aPTT, Clauss fibrinogen
  • Visual inspection of plasma for hemolysis
  • Urine analysis for hemoglobinuria

Return the blood component bag with administration set to the transfusion laboratory for investigation 1

Pathophysiology and Clinical Consequences

The clinical manifestations result from complete complement activation, formation of anaphylatoxins (C3a, C5a), and release of cytokines causing systemic inflammatory response syndrome 5, 6. This cascade leads to:

  • Hypotension and shock
  • Disseminated intravascular coagulation
  • Diffuse bleeding
  • Disruption of microcirculation leading to renal failure 5, 6

The risk of AHTR is approximately 1:70,000 per unit, with an estimated mortality risk of 1:1,250,000 RBC units transfused 1, 5.

Critical Pitfalls to Avoid

Do not wait to confirm the reaction type before stopping the transfusion 4. The first 10 minutes of infusion are critical—immediate reactions typically occur within the first minute 4.

Do not assume this is a benign febrile reaction simply because fever is present. The combination of IV site pain, respiratory distress, and fever within minutes mandates treating this as AHTR until proven otherwise 1.

Double-check all documentation for administration errors, particularly patient identification and blood component compatibility, as clerical errors remain the leading cause of ABO-incompatible transfusions 4, 7.

References

Guideline

Acute Hemolytic Transfusion Reaction

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Causes of Fever and Itching During Blood Transfusion

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Transfusion-Related Complications

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Research

Hemolytic Transfusion Reactions.

Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie, 2008

Research

Clinical presentation of haemolytic transfusion reactions.

Anaesthesia and intensive care, 1980

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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