Which signs would most strongly suggest a transfusion reaction during air transport?

• A. Nausea and mild headache
• B. Itching without other symptoms
• C. Fever, chills, rigors, hypotension, and dyspnea
• D. Abdominal pain only

Answer: (C)

The key idea is that a transfusion reaction causes systemic signs that reflect an inflammatory or immune-mediated process affecting circulation and lungs. When signs include fever with chills and rigors, plus low blood pressure and trouble breathing, it points to a true transfusion reaction rather than unrelated onboard symptoms. The fever and rigors show an immune or inflammatory response to donor blood components, hypotension indicates potential shock from the reaction, and dyspnea signals pulmonary involvement that can accompany severe reactions like TRALI, anaphylaxis, or septic-like transfusion reactions. Together, these findings are far more specific for a transfusion reaction than milder, nonsystemic symptoms.

Nausea with a mild headache, itching without other symptoms, or abdominal pain alone are much less specific and can arise from many benign causes on a flight, so they do not point as clearly to a transfusion reaction.