Which symptom combination describes an anaphylactic transfusion reaction?

• A. Hives, itching, stridor/shortness of breath, and/or hypotension
• B. Arm pain and back pain
• C. Nausea and fever only
• D. Chest pain with sweating

Answer: (A)

Anaphylactic transfusion reactions are rapid, life-threatening allergic responses to a blood transfusion that often occur in people with antibodies reacting to donor proteins (frequently IgA). The key pattern is sudden hives and itching, with airway involvement such as stridor or shortness of breath, and possible drop in blood pressure. This combination shows both skin/immune activation (hives, itching) and respiratory and circulatory compromise (stridor or dyspnea, hypotension), which is the hallmark of anaphylaxis.

Other symptom patterns don’t fit this reaction. Arm and back pain aren’t typical of anaphylaxis and more often point to other, nonallergic issues. Nausea with fever alone aligns with febrile non-hemolytic transfusion reactions, which lack the airway symptoms and hypotension. Chest pain with sweating could be a cardiac event or non-specific stress response and doesn’t reflect the allergic, airway-focused picture of anaphylaxis.

If this reaction were suspected, stop the transfusion immediately and treat per protocol with epinephrine and supportive care as needed.