Clinical Presentation - Febrile Non-Hemolytic Transfusion Reactions
Signs and symptoms of a Febrile Non-Hemolytic Transfusion Reaction (FNHTR) can appear during the transfusion or within four hours of its completion. They may include:
- fever (>/= 38 degrees C and a change of >/= 1 degree C from pretransfusion value)
- chills
- sensation of cold or
- rigors
- headache
- nausea
Mechanisms
FNHTR Mediated by Antibodies
The proposed mechanism for FNHTR to RBC is an antigen-antibody reaction between recipient antibodies to antigens on donor leukocytes in which cytokines are released by donor leukocytes. The cytokines released include interleukin 1 b (IL-1 b), interleukin 6 (IL-6), and tumor necrosis factor (TNF).
Another theory is that the recipient-donor WBC antigen-antibody reaction may activate complement, thus stimulating the recipient's macrophages to produce and release cytokines.
FNHTR Mediated by Accumulation of Cytokines During Storage
According to one proposed mechanism for FNHTR associated with transfusion of platelets, cytokines (IL-1 b,, IL-6, TNF), and possibly other biological response mediators, accumulate in the plasma in which platelets are stored and, when infused, cause the symptoms typical of these reactions. However, prestorage leukoreduction has not entirely eliminated the reactions, as would be expected if leukocyte-derived cytokines were solely responsible.