Which symptom is commonly associated with a transfusion reaction and warrants stopping the transfusion?

• A. Low back pain and headache
• B. Nausea only
• C. Mild tachycardia without symptoms
• D. Itching only

Answer: (A)

Recognizing signs of a transfusion reaction during an infusion and acting quickly is essential. Low back pain with a headache during a transfusion is a classic red flag for an acute transfusion reaction, often related to rapid testing positive for incompatibility. The back pain occurs because the body is reacting to free hemoglobin released from destroyed red cells, which can irritate the renal tract and capsule, while headache reflects systemic inflammatory and vasoactive mediator release. This combination strongly indicates a reaction that requires stopping the transfusion immediately and notifying the clinical team for further assessment and management.

The other symptoms listed are less specific. Nausea alone can occur for many reasons and isn’t as strongly linked to a transfusion reaction. Mild tachycardia without other symptoms can be nonspecific and not definitive for a reaction, and itching by itself could be an isolated mild allergic reaction. While some reactions can present with these signs, the combination of back pain and headache during transfusion is the most concerning and warrants stopping the transfusion to prevent progression of a potential reaction. If a reaction is suspected, stop the transfusion, assess the patient, and notify the clinician.