During a transfusion, if a patient's vital signs fluctuate significantly, which reaction might be suspected?

The scenario described, where a patient’s vital signs fluctuate significantly during a transfusion, is most indicative of a volume overload reaction. This condition occurs when there is an excessive amount of blood or blood products transfused in a short period, leading to increased blood volume. The heart and circulatory system may struggle to accommodate the volume, resulting in symptoms such as elevated blood pressure, dyspnea, or signs of heart failure, all of which contribute to the fluctuations observed in vital signs.

In contrast, febrile nonhemolytic reactions typically present with fever and chills but do not generally cause significant vital sign fluctuations in the same manner as volume overload. Acute hemolytic reactions, while serious and potentially life-threatening due to the rapid destruction of red blood cells, usually manifest with other symptoms such as severe pain, hemoglobinuria, and a drop in blood pressure rather than just vital sign fluctuations. Allergic reactions generally present with cutaneous symptoms such as hives and itching; while they can also affect vital signs, the nature of the changes is not typically as profound as those seen in volume overload reactions.

Overall, the significant fluctuation in vital signs during a transfusion strongly points to a volume overload reaction as the likely issue at hand.