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臨床情境 紅血球輸注開始 12 分鐘後，病人出現突發寒顫、嚴重下背痛、胸悶、低血壓、心搏過速與深紅色尿液，需要立即處理可能伴隨溶血與休克的嚴重輸血反應。 審查趨勢並選擇最佳的解釋和下一步計畫。

Trend

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Time	Data
Reaction recognition	BP 82/48 mm Hg; HR 128/min; chills, low-back pain, and dark-red urine血壓 82/48 mm Hg；心率 128/分；寒顫、下背痛和深紅色尿液
After initial response	Transfusion stopped; new saline tubing and supportive care started; BP 98/60 mm Hg; HR 108/min輸血停止；開始使用新的生理食鹽水管路和支持性照護；血壓 98/60 mm Hg；心率 108/分
Current laboratory trend	Urine output 12 mL/hour; creatinine rising; LDH elevated; haptoglobin low; plasma and urine hemoglobin present尿量 12 mL/小時；肌酸酐升高；LDH 升高；結合珠蛋白降低；血漿和尿液中存在血紅素

Q1. How should the trend be interpreted?應如何解釋此趨勢？

The reaction has completely resolved反應已完全解決 Hemolysis persists with evolving acute kidney-injury risk溶血持續存在並伴隨急性腎損傷風險 The findings indicate only local IV irritation這些發現僅表示局部靜脈刺激

Q2. Which next plan is appropriate?哪一個下一步計畫是適當的？

Continue renal-perfusion support and serial urine, renal, and coagulation monitoring繼續支持腎臟灌注並連續監測尿液、腎臟和凝血功能 Restart the red-cell unit because blood pressure improved因為血壓改善而重新啟動紅血球輸注 Wait for anuria before notifying the treatment team等待無尿發生後再通知治療團隊

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