Which finding is characteristic of a hemolytic transfusion reaction?

• A. Hemoglobinuria and hypotension
• B. Hives and itching
• C. Shortness of breath
• D. Nausea

Answer: (A)

In an acute hemolytic transfusion reaction, the recipient’s antibodies rapidly destroy donor red cells, causing intravascular hemolysis. This releases free hemoglobin into the plasma and urine, so hemoglobinuria is a key sign and can be accompanied by a drop in blood pressure from the inflammatory and vascular effects of the reaction. These features—hemoglobinuria together with hypotension—are classic for this type of reaction.

Hives and itching point to an allergic-type reaction to plasma proteins rather than intravascular hemolysis. Shortness of breath can occur in transfusion reactions due to lung involvement (like TRALI) or fluid overload, but it’s not specific for hemolysis. Nausea is nonspecific and not defining for hemolytic reactions.