Febrile non-hemolytic transfusion reaction

Febrile Non-Hemolytic Transfusion Reaction (FNHTR) is a common complication associated with blood transfusions. It is characterized by an increase in body temperature during or after a transfusion, without the presence of hemolysis (the destruction of red blood cells). FNHTR is considered to be a type of transfusion reaction, which encompasses any adverse event related to the transfusion of blood or blood products.

Causes

FNHTR is primarily caused by the recipient's immune response to donor white blood cells, platelets, or plasma proteins. The reaction is thought to be mediated by cytokines, which are released either from donor leukocytes present in the transfused blood product or from the recipient's leukocytes in response to the transfusion.

Symptoms

The main symptom of FNHTR is a rise in temperature of at least 1°C above the pre-transfusion level, reaching a temperature of 38°C or higher. Other symptoms may include chills, rigors, mild dyspnea (difficulty breathing), and a feeling of discomfort. Unlike hemolytic transfusion reactions, FNHTR does not involve hemoglobinuria or jaundice.

Diagnosis

Diagnosis of FNHTR is primarily clinical, based on the symptoms and the temporal relationship to a transfusion. Laboratory tests are typically performed to rule out hemolytic reactions, including a direct antiglobulin test (DAT) and measurements of plasma hemoglobin.

Prevention and Management

Preventive measures include the use of leukoreduced blood products, which have been filtered to remove white blood cells prior to transfusion. This significantly reduces the risk of FNHTR. Management of an FNHTR involves stopping the transfusion, administering antipyretics such as acetaminophen to reduce fever, and monitoring the patient. In most cases, the reaction is self-limiting and does not preclude future transfusions.

Epidemiology

FNHTR is one of the most common transfusion reactions, though its incidence has decreased with the widespread use of leukoreduction techniques. It can occur in patients receiving any type of blood product, but is most commonly associated with platelet transfusions.