Can blood be transfused in a patient with hyperpyrexia (high fever)?

From the Guidelines

Blood transfusions can generally be administered to patients with fever, but the situation requires careful medical evaluation, as indicated by the most recent guidelines from 2017 1. If a patient needs blood due to severe anemia or blood loss, doctors typically won't withhold a necessary transfusion solely because of fever. However, fever could be a sign of infection or a transfusion reaction if it develops during the transfusion. Medical staff will monitor vital signs closely during the procedure and may treat the fever with antipyretics like acetaminophen before or during the transfusion. The underlying cause of the fever should be investigated, as infections might need to be addressed before transfusion in non-emergency situations. Blood products are typically warmed to body temperature before administration to prevent causing additional temperature changes. Some key considerations for transfusion include:

• The patient's hemoglobin concentration, with a threshold of <7.0 g/dL recommended for transfusion in adults without extenuating circumstances 1
• The presence of symptoms such as myocardial ischemia, severe hypoxemia, or acute hemorrhage, which may necessitate transfusion at a higher hemoglobin threshold
• The risk of bleeding, with higher platelet counts advised for active bleeding, surgery, or invasive procedures 1 The decision to transfuse ultimately depends on weighing the urgency of the patient's need for blood against the risks of transfusing during fever, and should always be made by healthcare professionals based on the individual clinical situation, taking into account the latest guidelines and evidence from studies such as those published in 2012 1 and 2017 1, as well as 2013 1.

From the Research

Blood Transfusion and Fever

• Blood transfusions are generally safe but can carry considerable risks, including transfusion reactions and adverse events 2.
• Febrile nonhemolytic transfusion reactions (FNHTRs) are a type of transfusion reaction that can occur, and leukoreduction has been shown to be effective in minimizing FNHTRs 3.
• However, the use of premedications such as acetaminophen and diphenhydramine to minimize transfusion-related reactions is not supported by research 3.
• Fever management is crucial in patients receiving blood transfusions, and antipyretics such as acetaminophen and ibuprofen can be effective in reducing fever by inhibiting prostaglandin synthesis 4.

Transfusion Guidelines

• Indications for blood products should be carefully adapted to the patient's current clinical situation, and pre-existing diseases should be considered 5.
• Evidence-based transfusion thresholds for packed red blood cell concentrates (RBC) have been defined for most perioperative elective surgeries 5.
• Platelet concentrates (PC) should be transfused in bleeding patients with thrombocytopenia or -pathy, and prophylactically in clinically stable, not bleeding patients with a platelet trough count of less than 10/nl 5.

Safety Considerations

• The transfusion of blood and blood products is not without risk, and significant among these risks is the potential for human error and the subsequent transfusion of the incorrect blood component 6.
• Adopting all-inclusive and rigorous blood transfusion procedures can help to minimize the risk of errors and ensure safe practice 6.