An acute hemolytic transfusion reaction occurs when the red blood cells are destroyed during transfusion. The ruptured red blood cells release of hemoglobin into the plasma. The patient will exhibit chills, fever, flank pain, tachycardia, oozing from intravenous site, and difficulty breathing. Angioedema and wheezing are associated with an anaphylactic transfusion reaction. In the event of an acute hemolytic transfusion reaction, the nurse should stop the transfusion immediately, and provide aggressive hydration and diuresis.