Which condition requires starting the blood transfusion at a slow rate for the first 15 minutes?

Starting a blood transfusion at a slow rate for the first 15 minutes is primarily a precautionary measure to monitor for any potential adverse reactions, especially in patients who might be at higher risk for transfusion complications. The recommended practice is to begin with a slow infusion to allow healthcare providers to observe the patient's response before gradually increasing the rate.

In the case of circulatory overload, the risk is particularly relevant. Some patients may already have compromised cardiac function or fluid overload issues, and starting slowly helps prevent excessive volume from being introduced too quickly, which could exacerbate the situation and lead to heart failure or other complications.

For febrile nonhemolytic reactions and anaphylactic reactions, while monitoring is essential and starting slowly can be beneficial, the specific emphasis on slow initiation is more critical in patients at risk for circulatory overload because of the immediate risk that a rapid infusion poses.

Although all conditions listed can result in severe reactions that require vigilant monitoring, the guideline of starting at a slow infusion rate for the first 15 minutes particularly addresses the concerns associated with circulatory overload. Thus, identifying that condition highlights a key practice in blood transfusion safety.