Which of the following lists the signs of an acute hemolytic transfusion reaction (AHTR)?

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Acute hemolytic transfusion reactions stem from intravascular destruction of donor red cells, usually from ABO incompatibility. This rapid hemolysis releases free hemoglobin into the blood and urine and triggers a systemic response. The hallmark signs come from that process: fever and chills during the transfusion, flank or back pain from renal irritation caused by hemolyzed cells, hypotension from the acute inflammatory/shock response, and the laboratory/clinical clue of hemoglobinemia or hemoglobinuria (dark urine). Seeing this combination—fever and chills with flank/back pain, low blood pressure, and hemoglobinemia/hemoglobinuria—points to an acute hemolytic reaction. An isolated fever with chills can occur in other transfusion reactions, flank pain alone isn’t specific, and a rash with itching suggests an allergic reaction, not intravascular hemolysis.