Pediatric ATI Practice Exam

Which finding indicates the child is having a hemolytic reaction after a transfusion?

1. Chills and flank pain

2. Pruritus and flushing

3. Rales and cyanosis

4. Bradycardia and diarrhea

The correct answer is: Chills and flank pain

The presence of chills and flank pain is a classic indicator of a hemolytic transfusion reaction. This type of reaction occurs when the immune system attacks the transfused red blood cells, often due to blood type incompatibility. Chills can occur as part of the body's response to the release of pyrogens or as a reaction to the inflammatory process initiated by the hemolysis. Flank pain arises from the kidneys' involvement in the reaction, as hemolysis can lead to the release of hemoglobin into the bloodstream, which can be damaging to the renal tubules. This pain typically presents in the lower back or sides, corresponding to the location of the kidneys. In contrast, pruritus and flushing are more commonly associated with allergic reactions to transfusions, rales and cyanosis signal respiratory distress or fluid overload, and bradycardia and diarrhea can suggest other types of systemic reactions but aren't specific to hemolytic reactions. Hence, chills and flank pain are the hallmark signs that directly correlate with the onset of a hemolytic reaction.