Prevention - Febrile Non-Hemolytic Transfusion Reactions

Canadian Blood Services (CBS) has adopted universal prestorage leukoreduction, in which leukocytes are removed from RBC and platelet components as part of the preparation process prior to storage.

• Prestorage leukoreduction to a threshold of 5 X 106 per component can prevent most FNHTR associated with RBC and platelet component transfusions.

Another strategy is to pre-medicate patients who have experienced two suspected FNHTR with acetaminophen and diphenhydramine, although its efficacy has not been well-studied.

Because prestorage leukoreduction cannot prevent the accumulation of some biological response mediators in platelet components such as IL-8, C3a, and C4a, an additional approach to preventing FNHTR associated with platelet components may be to remove the plasma just prior to transfusion. Currently this strategy is not routinely used, although it has been shown to be effective in preventing severe reactions to platelets. (See Further Reading: Heddle et al., Transfusion 2002.) .