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The page below is a sample from the LabCE course Transfusion Reactions. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Febrile Nonhemolytic Transfusion Reactions: Definition, Manifestation, and Prevalence

Fever is a symptom that occurs in a number of categories of transfusion reactions. It can also be associated with the patient's underlying condition. If the transfused patient develops a fever (usually defined as at least a 1° C rise from the baseline), during or after the transfusion of blood components, the patient must first be assessed for a hemolytic reaction. If the laboratory assessment for hemolysis is negative, then a culture is usually requested to rule out a bacterially contaminated blood component. When other sources of the fever have been ruled out, the reaction is categorized as a non­hemolytic febrile transfusion reaction (NHFTR).
There are two mechanisms involved in the manifestation of an FNHTR. The first involves the presence of a white cell antibody in the patient's plasma that interacts with antigens on platelets or leukocytes in the blood product. These antibodies may be directed against granulocyte antigens or human leukocyte antigens (HLA). This interaction causes endotoxins to be released, which act on the hypothalamus and stimulate a fever. The second mechanism involves the generation of leukocyte cytokines during product storage. The use of prestorarge leukocyte-reduced blood components will reduce or eliminate the possibility of NHFTR.