Medicine:Febrile non-hemolytic transfusion reaction

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Febrile non-hemolytic transfusion reaction
Other namesFebrile-type reaction
SpecialtyHematology

Febrile non-hemolytic transfusion reaction (FNHTR) is the most common type of transfusion reaction. It is a benign occurrence with symptoms that include fever but not directly related with hemolysis.[1] It is caused by cytokine release from leukocytes within the donor product as a consequence of white blood cell breakdown [2] [3][4].These inflammatory mediators accumulate during the storage of the donated blood,[5] and so the frequency of this reaction increases with the storage length of donated blood.[6] This is in contrast to transfusion-associated acute lung injury, in which the donor plasma has antibodies directed against the recipient HLA antigens, mediating the characteristic lung damage.[citation needed]

Definition

Symptoms must manifest within 4 hours of cessation of the transfusion, and should not be due to another cause such as an underlying infection, bacterial contamination of the blood component, or another type of transfusion reaction, e.g. acute hemolytic transfusion reaction.[7]

Fever must be at least 38 °C/100.4 °F oral and a change of at least 1 °C/1.8 °F from pre-transfusion value OR chills and/or rigors must be present.[7][8]

The UK hemovigilance system (SHOT) categorizes the severity of the reaction.[9]

Mild

Fever of at least 38 °C/100.4 °F oral and a change of between 1 and 2 °C from pre-transfusion values but no other symptoms or signs.[9]

Moderate

Fever of at least 39 °C, OR a rise in temperature of at least 2 °C from pre-transfusion values AND/OR other symptoms or signs, including chills (rigors), painful muscles (myalgia), or nausea that are severe enough that the transfusion is stopped.[9]

Severe

Fever of at least 39 °C, OR a rise in temperature of at least 2 °C from pre-transfusion values AND/OR other symptoms or signs, including chills (rigors), painful muscles (myalgia), or nausea that are severe enough that the transfusion is stopped AND requires immediate medical treatment, admission to hospital, or lengthens the duration of hospital admission.[9]

Treatment

Paracetamol has been used in treatment, and leukoreduction of future transfusions is sometimes performed.[10]

References

  1. ↑ Heddle NM (November 1999). "Pathophysiology of febrile nonhemolytic transfusion reactions". Curr. Opin. Hematol. 6 (6): 420–6. doi:10.1097/00062752-199911000-00012. PMID 10546797. 
  2. ↑ Sharma, RR; Marwaha, N (January 2010). "Leukoreduced blood components: Advantages and strategies for its implementation in developing countries.". Asian Journal of Transfusion Science 4 (1): 3–8. doi:10.4103/0973-6247.59384. PMID 20376259. 
  3. ↑ "The association of cytokine gene polymorphisms with febrile non-hemolytic transfusion reaction in multitransfused patients". Transfus Med 16 (3): 184–91. June 2006. doi:10.1111/j.1365-3148.2006.00665.x. PMID 16764597. 
  4. ↑ "The effect of prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reactions to platelet concentrates and RBC". Transfusion 44 (1): 10–5. January 2004. doi:10.1046/j.0041-1132.2003.00518.x. PMID 14692961. 
  5. ↑ Le, Tao; Bhushan, Vikas; Sochat, Matthew; Vaidyanathan, Vaishnavi (3 January 2020). First Aid for the USMLE Step 1 2020: 30th Anniversary Edition (30th Anniversary ed.). McGraw Hill Education. p. 114. ISBN 978-1-26-046205-0. 
  6. ↑ Kumar, Vinay; Abbas, Abul K.; Aster, Jon C., eds (28 March 2017). Robbins Basic Pathology (Tenth ed.). Philadelphia, Pennsylvania: Elsevier. p. 491. ISBN 978-0-323-35317-5. 
  7. ↑ 7.0 7.1 "Proposed standard definitions for surveillance of noninfectious adverse transfusion reactions". http://www.isbtweb.org/fileadmin/user_upload/Proposed_definitions_2011_surveillance_non_infectious_adverse_reactions_haemovigilance_incl_TRALI_correction_2013.pdf. 
  8. ↑ "NHSN | CDC" (in en-us). 2017-12-29. https://www.cdc.gov/nhsn. 
  9. ↑ 9.0 9.1 9.2 9.3 Bolton-Maggs, PHB; Poles, D (2018). "The 2017 Annual SHOT Report". SHOT. https://www.shotuk.org/wp-content/uploads/myimages/SHOT-Report-2017-WEB-Final-v4-25-9-18.pdf. 
  10. ↑ "Complications of Transfusion: Transfusion Medicine: Merck Manual Professional". http://www.merck.com/mmpe/sec11/ch146/ch146e.html#sec11-ch146-ch146d-1093. 

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