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Diagnosis, Treatment, and Prevention of FNHTR

Diagnosing a febrile nonhemolytic transfusion reaction (FNHTR) involves excluding all other options that may present with fever. If this type of reaction is suspected, the transfusion should be stopped. A transfusion reaction work-up should be initiated. If the initial testing is negative, a culture may be ordered to rule out a bacterially-contaminated blood component.  Antibodies involved with these reactions are not routinely identified because of the difficulty in demonstrating their presence in vitro. Antipyretics, such as acetaminophen, should be administered to the patient and the transfusion can continue once the symptoms subside.

A patient with two or more documented FNHTRs should receive leukocyte-reduced blood components.

Pre-storage leukocyte reduction prevents reactions that occur due to cytokine accumulation during storage. Red cell component prevention techniques include the transfusion of fresher blood or washed blood. For platelets, residual plasma may be removed. Antipyretics can be administered prior to transfusion.