Transfusion medicine handbook

7. Adverse Effects of Transfusion

7.4 Febrile Non-haemolytic Transfusion Reaction

Fever or rigors during red cell transfusion affect 1 - 3% of recipients and in the past were usually attributed to the transfusion of white cells present in blood components. Febrile non-haemolytic transfusion reactions (FNHTR) generally occur more frequently in patients who have been alloimmunised to leucocyte antigens as a result of pregnancy or recurrent transfusion. The use of leucocyte-depleted blood components has undoubtedly reduced the occurrence of FNHTR, however the relatively large number of reactions still seen suggests the involvement of other mechanisms and risk factors. Febrile reactions during platelet transfusion have been attributed to leucocyte- and platelet-derived cytokines that accumulate in the product during storage.

Classical symptoms of FNHTR are shivering, usually 30 - 60 minutes after the start of the transfusion, followed by fever. Most reactions can be managed initially by stopping the transfusion and giving an antipyretic such as paracetamol. FNHTR, although unpleasant, is not life-threatening. However, fever or rigors can also be early symptoms of a severe acute haemolytic transfusion reaction or transfusion of bacterially contaminated blood.

Recurrent severe FNHTR in patients who require repeated transfusion of red cells or platelets may be prevented by the use of washed cellular components.

Premedication

While treatment of FNHTR with antipyretics such as paracetamol for a symptomatic rise in temperature may be justified, routine premedication with antipyretics and/or antihistamines prior to transfusion is not advised as it is both unnecessary and may modify important signs of a transfusion reaction. Steroids are not appropriate for the treatment or prevention of FNHTR.