Transfusion medicine
Transfusion reactions
Febrile nonhemolytic

Topic Completed: 1 September 2011

Minor changes: 16 July 2020

Copyright: 2002-2019,, Inc.

PubMed Search: "Febrile nonhemolytic transfusion reaction"

Huy Phu Pham, M.D., M.P.H.
Page views in 2019: 1,926
Page views in 2020 to date: 886
Cite this page: Pham HP Febrile nonhemolytic. website. Accessed August 14th, 2020.
Definition / general
  • Increase of > 1 degree Centigrade associated with transfusion, without hemolysis, that cannot be attributed to other causes (diagnosis of exclusion)
  • Usually occurs within 2 hours of transfusion
  • 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)
  • Varies with types of product transfused and patient population
  • pRBCs: 0.1 - 7%, reduced by 50% with prestorage leukoreduced pRBCs
  • Platelets: 0.2 - 30%, reduced by 90% with prestorage leukoreduced platelets
  • Underreported in cancer patients (MedGenMed 2004;6:17)
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