# Ten minutes into a PRBC transfusion, a client develops chills, fever, severe back pain, dyspnea, and red urine. Which is the priority sequence of actions?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391883&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Ten minutes into a PRBC transfusion, a client develops chills, fever, severe back pain, dyspnea, and red urine. Which is the priority sequence of actions?

## Option

1. Administer additional PRBC for hypotension
2. STOP transfusion immediately, disconnect tubing at the IV hub, maintain IV with NS via new tubing, notify provider and blood bank, send remaining unit + tubing + new specimens back, monitor for shock/DIC/AKI, treat per protocol **✔ Correct answer**
3. Continue infusion and give acetaminophen
4. Slow the rate to half and observe

**Correct answer: 2**

## Explanation

Correct (2): Classic acute hemolytic transfusion reaction (ABO incompatibility) — chills, fever, flank/back pain, hypotension, hemoglobinuria, dyspnea, DIC, AKI. STOP transfusion, DISCONNECT TUBING (do not just clamp), maintain IV with NS via NEW tubing, notify, send unit + new blood/urine specimens for workup, supportive care. (1,3,4) Continue to expose client to fatal antigen.

## In-depth explanation

Memory Tip Acute hemolytic = "Fever + Flank pain + Red urine + Shock" within 15 min. STOP-DISCONNECT-SALINE-NOTIFY-SEND. Differentiate from febrile non-hemolytic (fever only, no hemolysis signs).

## Clinical scenario

Scenario 50-year-old female 10 min into PRBC transfusion; new chills, fever 38.6°C, severe back pain, dyspnea, red urine, BP dropping.

## Key concepts

- **Acute hemolytic transfusion reaction** — ABO incompatibility; intravascular hemolysis; DIC, AKI; fatal without immediate action.
- **STOP-DISCONNECT-SALINE** — Stop transfusion, disconnect tubing (not just clamp), maintain IV with NS via new tubing.
- **Transfusion reaction types** — Acute hemolytic, febrile non-hemolytic, allergic/anaphylaxis, TRALI, TACO, septic, delayed hemolytic.

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