Transfusion

Items hand you symptoms mid-transfusion and ask you to name the reaction. Fever, chills, and back/flank pain with red or tea-colored urine point to an acute hemolytic (ABO-incompatible) reaction — the deadliest, almost always a clerical/identity mismatch; hives, wheezing, and dyspnea suggest allergic/anaphylactic; crackles, dyspnea, and JVD signal circulatory overload (TACO), where you sit the client up and anticipate a diuretic (stopping is also correct — at minimum slow the rate sharply). For a suspected hemolytic or febrile reaction the move is the same: stop the blood, disconnect the tubing, and run normal saline through new tubing so you protect the kidneys without pushing more incompatible cells.

Don’t confuse this with hemorrhage (why you transfuse) or coagulation — citrate in stored blood binds calcium, so massive transfusion risks hypocalcemia and hyperkalemia, not a PT/aPTT problem. A two-person, two-identifier bedside check matching the band to the bag prevents the lethal ABO error. Memory hook: “Stop, Saline, Stay.”