Febrile Non-Hemolytic Transfusion Reactions
Description
Febrile Non-Hemolytic Transfusion Reactions (FNHTR) are one of the most common complications of transfusion. As defined by the TTISS (Transfusion Transmitted Injuries Surveillance System) this would be suspected if the recipient experienced one or more of the following:
- fever (>/= 38 degrees Celsius (use symbols) and a change of >/= 1 degree Celsius from pretransfusion value),
- chills
- sensation of cold or
- rigors
NOTE: Because patients are often pretreated with antipyretic drugs, FNHTRs are not always associated with fever.
The most likely cause of FNHTR due to red blood cell (RBC) transfusion is antibodies in the recipient's plasma directed against leukocytes in the red cell component. Patients are often multi-transfused or multiparous. In contrast, most FNHTR due to platelets are probably caused by cytokines that accumulate in the product during storage. Prestorage leukoreduction has reduced the frequency, but has not entirely eliminated these reactions (see Mechanism under Clinical Presentation).
Incidence
The incidence of FNHTR varies with the patient population and type of component, its preparation method, and its storage age. As well, reported incidence rates vary according to diagnostic criteria and the level of surveillance.
There is a pronounced difference in frequency for reactions to red cells versus platelets. The reported incidence of FNHTRs to red cells is about one per cent in the general hospital population and higher in patients with hematologic malignancy, thalassemia, or sickle cell anemia.
The incidence of FNHTR with prestorage leukoreduced platelets has been reported to be approximately six to eight per cent. Severe reactions characterized by chills and rigors occurred in only one to two per cent of transfusions with WBC-reduced platelets. (Further Reading: Heddle et al., Transfusion, May 2002).
Although usually self-limited and not associated with lasting sequelae, FNHTR can cause significant distress to patients.