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Transfusion medicine

Tranfusion reaction

Febrile nonhemolytic transfusion reaction (FNHTR)

Reviewer: Huy Phu Pham, M.D. (see Reviewers page)
Revised: 1 November 2011, last major update September 2011
Copyright: (c) 2007-2011, PathologyOutlines.com, Inc.


● Increase of > 1 degree C associated with transfusion, without hemolysis, that cannot be attributed to other causes (diagnosis of exclusion)
● Usually occurs within 2 hours of transfusion


● Varies with types of product transfused and patient population
● pRBCs: 0.17%, reduced by 50% with pre-storage leukoreduced pRBCs
● Platelets: 0.230%, reduced by 90% with pre-storage leukoreduced platelets
● Underreported in cancer patients (MedGenMed 2004;6:17)


● Associated with leukocytes
● Either: (a) leukocyte-derived cytokines accumulate during storage (mostly associated with platelets, platelets are stored at room temperature -> contaminating leukocytes remain functional); or
● (b) recipient WBC antibodies against leukocytes transfused --> antigen-antibody complex --> release of endotoxin --> fever (mostly associated with pRBCs)

Clinical features

● Fever; may be accompanied by chills, rigors, cold and discomfort
● No complications, but costs time and money to rule out more serious transfusion reactions


● Must exclude all causes for fever, such as bacterial contamination, TRALI, hemolytic transfusion reaction, underlying disease (diagnosis of exclusion)
● Need to have clear temporal relationship with transfusion

Treatment and management

● Stop the transfusion
● Notify the transfusion medicine service
● Rule out other causes, such as hemolysis (DAT, visual check for hemoglobinemia), bacterial contamination (culture the product if necessary)
Symptomatic treatment: Acetaminophen
● Pretreatment with acetaminophen and diphenhydramine: could potentially benefit patient, but does not save money (Arch Pathol Lab Med 2004;128:991, Transfus Med Rev 2007;21:1)


● Pre-storage leukoreduction (Transfusion 2004;44:10, Transfusion 2004;44:25, Transfusion 2001;41:997)
● Consider volume-reduced or washed products
● Pre-medication with acetaminophen may mask the fevers caused by other serious reactions

End of Transfusion Medicine > Tranfusion reaction > Febrile nonhemolytic transfusion reaction (FNHTR)

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