Epidemiology

• Incidence: most common type of transfusion reaction

---

Physiology

• Mechanism: believed to be associated with class I HLA antibodies (or sometimes granulocyte specific antibodies) directed against the contaminating leukocytes in the transfused blood product
  • However, such antibodies are not always found

---

Diagnosis

Chest X-Ray (CXR) (see Chest X-Ray, [[Chest X-Ray]])

• May demonstrate peri-hilar nodular and LL infiltrates

---

Clinical Manifestations

General Comments

• Associated Blood Products
  • Packed Red Blood Cells (see Packed Red Blood Cells, [[Packed Red Blood Cells]])
  • Platelets (see Platelet Transfusion, [[Platelet Transfusion]]): may be contaminated with leukocytes
• Onset: 1-6 hrs after transfusion of red blood cells or platelets

Pulmonary Manifestations

• Mild Dyspnea (see Dyspnea, [[Dyspnea]])
• Transfusion-Associated Acute Lung Injury (TRALI) (see Transfusion-Associated Acute Lung Injury, [[Transfusion-Associated Acute Lung Injury]])

Other Manifestations

• Chills
• Fever (see Fever, [[Fever]])

---

Treatment

• Stop the Transfusion: usually resolves without sequelae
• Rule Out a Acute Hemolytic Transfusion Reaction (see Acute Hemolytic Transfusion Reaction, [[Acute Hemolytic Transfusion Reaction]])
• Anti-Pyretics: aspirin should be avoided in the setting of thrombocytopenia
• Meperidine (Demerol) (see Meperidine, [[Meperidine]]): for severe chills and rigors

---

Risk of Recurrence

• Approximately 40% of Patients Experiencing a Febrile Non-Hemolytic Transfusion Reaction will Experience Another Febrile Non-Hemolytic Transfusion Reaction [MEDLINE]: 24% will experience it on their next transfusion

---

Prevention

• Leukoreduction: although it is thought that this may decrease the risk of acute febrile non-hemolytic transfusion reaction, the results from trials are conflicting
  • Systematic Review Examining Impact of Leukoreduction on Various Adverse Outcomes of PRBC Transfusion (Cochrane Database Syst Rev, 2015) [MEDLINE]
    • Leukoreduction did not decrease the incidence of TRALI, death (from any cause), infection from any cause, fever, or other non-infectious complications
• Premedication with Acetaminophen (Tylenol) and Diphenhydramine (Benadryl) (see Acetaminophen, [[Acetaminophen]] and Diphenhydramine, [[Diphenhydramine]])
  • Prospective Trial Examining Efficacy of Premedication for Leukoreduced Transfusions (Transfusion, 2008) [MEDLINE]
    • Premedication did not decrease the overall risk of all types transfusion reactions
    • However, premedication decreased the rate of febrile non-hemolytic transfusion reactions

---

References

• A prospective, randomized, double-blind controlled trial of acetaminophen and diphenhydramine pretransfusion medication versus placebo for the prevention of transfusion reactions. Transfusion. 2008;48(11):2285 [MEDLINE]
• Leukoreduction for the prevention of adverse reactions from allogeneic blood transfusion. Cochrane Database Syst Rev. 2015 Dec 3;12:CD009745. doi: 10.1002/14651858.CD009745.pub2 [MEDLINE]