Hemoglobinuria and hypotension are symptoms of which type of transfusion reaction?

• A. Hemolytic
• B. Febrile non-hemolytic
• C. Anaphylactic
• D. TRALI

Answer: (A)

Hemoglobinuria and hypotension occur with an intravascular hemolytic transfusion reaction, most often from ABO incompatibility. When red cells are destroyed inside vessels, free hemoglobin is released into the plasma and filtered by the kidneys, causing dark urine (hemoglobinuria). The massive intravascular destruction and the inflammatory response can also lead to loss of vascular tone and shock, producing hypotension. Febrile non-hemolytic reactions mainly cause fever and chills without hemolysis; anaphylactic reactions present with rapid airway symptoms and shock but not typically hemoglobinuria; TRALI causes acute lung injury with hypoxemia and pulmonary edema, not intravascular hemolysis.