Acute Granulocytic Febrile Transfusion Reaction

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
  • Onset: 1-6 hrs after transfusion of red blood cells or platelets

Pulmonary Manifestations

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]