病人正在進行輸血，下列哪些徵象顯示可能發生急性溶血反應？（選所有適合的）

核心概念：急性溶血反應（Acute hemolytic reaction）是輸血（blood transfusion）過程中嚴重的免疫性不良反應，通常是因 ABO 血型不合導致的紅血球被快速破壞。辨識其早期症狀對及時處理至關重要。 為何正確答案 A, B, C, D 對： A. 腰痛（Low back pain）：這是急性溶血反應的典型早期症狀之一。被破壞的紅血球釋放的血紅素（hemoglobin）可能沉積在腎小管，引起腎臟損傷和疼痛。 B. 發燒與寒顫（Fever and chills）：輸注不相容的血液會引發免疫反應，導致體溫升高和寒顫。 C. 心搏過速（Tachycardia）：身體為應對血容量下降（因紅血球被破壞）和潛在的低血壓，會加速心跳來代償。 D. 低血壓（Hypotension）：嚴重的溶血反應會導致血管內溶血，釋放血管活性物質，並可能引發瀰漫性血管內凝血（DIC），造成血壓急劇下降。 為何其他選項錯： E. 喘鳴（Wheezing）：喘鳴是呼吸道阻塞或支氣管痙攣的表現，更常見於輸血相關的過敏反應（anaphylactic reaction）或體液過量（TRALI/TACO），而非急性溶血反應的典型症狀。 臨床思路/安全優先：輸血不良反應的處理原則是「立即停止輸血」。護理師在輸血開始的最初 15 分鐘內應密切監測病人的生命徵象和主訴，一旦出現溶血反應的跡象（如腰痛、發燒、寒顫、血壓下降、心跳加速），應立即停止輸注，並執行相應的處理步驟（如維持靜脈輸液、通知醫師、收集血液和尿液樣本進行檢測）。

Core concept: An acute hemolytic reaction is a severe immune-mediated adverse event during blood transfusion, typically caused by ABO incompatibility that leads to rapid destruction of red blood cells. Early recognition of its signs is essential for timely management. Why answers A, B, C, D are correct: A. Low back pain: a classic early manifestation of acute hemolytic reaction. Hemoglobin released from destroyed red blood cells may be deposited in the renal tubules, causing renal injury and pain. B. Fever and chills: transfusion of incompatible blood triggers an immune response, resulting in elevated temperature and chills. C. Tachycardia: in response to decreased blood volume (from red cell destruction) and impending hypotension, the heart compensates by increasing its rate. D. Hypotension: severe hemolytic reactions cause intravascular hemolysis, release vasoactive substances, and may trigger disseminated intravascular coagulation (DIC), leading to a rapid drop in blood pressure. Why the other option is incorrect: E. Wheezing: reflects airway obstruction or bronchospasm, and is more typical of transfusion-related allergic/anaphylactic reactions or fluid overload (TRALI/TACO) rather than acute hemolytic reaction. Clinical reasoning/safety priority: The cardinal rule for managing any transfusion reaction is to STOP the transfusion immediately. The nurse should closely monitor vital signs and the client's subjective complaints during the first 15 minutes of transfusion. At the first signs of a hemolytic reaction (back pain, fever, chills, falling blood pressure, tachycardia), the infusion must be stopped immediately and subsequent steps performed (maintain IV access with normal saline, notify the physician, and collect blood and urine specimens for testing).