Symptoms of a hemolytic transfusion reaction can vary depending on whether the reaction is acute or delayed. Acute reactions typically occur within 24 hours of the transfusion and may include fever, chills, back pain, dark urine, and jaundice. In more severe cases, the patient may experience shock, renal failure, or disseminated intravascular coagulation (DIC). Delayed reactions can occur days to weeks after transfusion and often present with mild symptoms such as fever and anemia.