Which finding indicates a febrile transfusion reaction during a unit of packed RBCs?

• A. Temperature increase from baseline
• B. Hypotension
• C. Nausea and vomiting
• D. Itching

Answer: (A)

Fever during a blood transfusion is the hallmark of a febrile non-hemolytic transfusion reaction. This reaction arises when cytokines accumulate in the donor unit or when the recipient has antibodies that react to donor leukocytes, leading to a rise in temperature. Because fever is the defining feature of this type of reaction, a temperature increase from baseline during the transfusion most clearly signals this condition. Other symptoms like hypotension, nausea/vomiting, or itching can occur with various transfusion reactions or allergic responses, but they are not as specifically linked to febrile non-hemolytic reactions as a fever is.