What is the diagnosis for a patient experiencing shortness of breath, chest pain, and hypotension within the first 2 minutes of a blood transfusion?

The diagnosis of a hemolytic transfusion reaction is strongly indicated in a patient presenting with shortness of breath, chest pain, and hypotension shortly after the initiation of a blood transfusion, particularly within the first 2 minutes. This type of reaction occurs when the recipient's immune system recognizes the transfused red blood cells as foreign due to incompatible blood types, activating complement and leading to hemolysis, which can cause acute cardiovascular and respiratory symptoms. The rapid onset of symptoms aligns with the immediate-type hypersensitivity response associated with hemolytic reactions.

In contrast, a febrile non-hemolytic reaction typically presents with fever and chills rather than chest pain and hypotension, occurring later in the transfusion process. Allergic reactions can cause symptoms such as hives or itching but usually do not lead to severe hypotension or chest pain. Transfusion-associated circulatory overload, while also related to blood transfusion, generally develops more progressively and is characterized by symptoms associated with fluid overload, such as dyspnea and elevated blood pressure, rather than hypotension. Thus, the acute symptoms described strongly correlate with a hemolytic transfusion reaction.