CAMLPR Transfusion Practice Test

How is febrile nonhemolytic transfusion reaction (FNHTR) defined and managed?

Fever days later after transfusion; unrelated

Itching and hives within minutes; stop transfusion and give steroids

Immediate fever and hypotension during transfusion; treat with epinephrine

Fever with chills within a few hours of transfusion without signs of hemolysis; stop transfusion, treat fever, and consider leukoreduced products for future transfusions

Fever with chills occurring within a few hours of a transfusion, without signs of hemolysis, defines febrile nonhemolytic transfusion reaction. This reaction is typically due to recipient cytokine responses to donor leukocytes or, less commonly, antibodies to donor leukocytes. Because there is no hemolysis, the focus is on stopping the transfusion if symptoms are significant, treating the fever, and evaluating for other causes if needed.

Management involves stopping the transfusion when fever or other symptoms arise, providing supportive care such as antipyretics (for example, acetaminophen) to control the fever, and monitoring the patient. If there is no evidence of hemolysis or infection and the patient stabilizes, future transfusions can use leukoreduced blood products to reduce the risk of recurrence.