Febrile Nonhemolytic Transfusion Reaction

Aka: Febrile Nonhemolytic Transfusion Reaction, FNHTR

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II. Pathophysiology

  1. White Blood Cells in Blood Product stimulate transfusion recipient Antibody binding reaction OR
  2. Proinflammatory Cytokines contained in Blood Product

III. Risk Factors

  1. Increased risk
    1. Repeat transfusions
    2. Pregnancy
    3. Platelet Transfusions
      1. Replaced pRBC transfusion as most common cause (due to Leukocyte reduced pRBC transfusion)
  2. Decreased risk
    1. Leukocyte reduced pRBC transfusion
      1. Filtering out Leukocytes from pRBCs prior to storage has resulted in decreased Incidence of FNHTR

IV. Signs

  1. Fever or Temperature increase of 1.8 F (1 C) within 4 hours of transfusion
  2. Chills
  3. Rigors
  4. Hypertension
  5. Tachycardia
  6. Tachypnea

V. Precautions

  1. FNHTR is a diagnosis of exclusion
  2. Exclude more serious causes in differential diagnosis

VI. Differential Diagnosis

  1. Other causes of fever (e.g. Sepsis)
  2. Transfusion Hemolysis

VII. Management

  1. Symptomatic
  2. Antipyretics
    1. Prophylactic use does NOT prevent reaction
    2. However, consider prophylaxis when prior FNHTR reaction, as it may allow for transfusion completion

VIII. Prevention

  1. Leukocyte reduction (leukoreduction) of cellular Blood Products (e.g. Packed Red Blood Cells)
  2. Washing and volume reduction of Platelet Transfusion

IX. References

  1. Raval (2020) Am Fam Physician 102(1):30-8 [PubMed]
  2. Sharma (2011) Am Fam Physician 83(6): 719-24 [PubMed]

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