What is the treatment for chills during blood transfusion?

Management of Chills During Blood Transfusion

Blood warming using approved blood warming equipment is the primary intervention for managing chills during blood transfusion, along with appropriate symptomatic treatment including paracetamol for febrile reactions. 1

Immediate Management Algorithm

When a patient experiences chills during blood transfusion:

1. Assess severity and associated symptoms

   • Check vital signs (temperature, blood pressure, heart rate, respiratory rate)
   • Determine if chills are accompanied by fever, hypotension, or respiratory distress

2. Initial interventions based on severity:

   • Grade 1/2 (mild to moderate):

     • Slow or temporarily stop the transfusion
     • Administer IV paracetamol (1g) for febrile symptoms 2
     • Resume transfusion at half the previous rate after symptoms improve

   • Grade 3/4 (severe):

     • Stop the transfusion immediately
     • Provide aggressive symptomatic treatment
     • Consider permanent discontinuation if severe reaction 1

Specific Interventions for Chills

Blood Warming

• Use approved, specifically designed blood warming equipment to warm blood components to 37°C 1
• Blood warmers must have visible thermometer and audible warning systems
• Monitor temperature settings regularly throughout transfusion
• CAUTION: Never use improvised warming methods (warm water, microwave, radiator) 1

Pharmacological Management

• For febrile reactions: IV paracetamol is the primary treatment 1, 2
• For allergic components: Use antihistamines only (not steroids) 1
• For severe reactions with hypotension: Consider vasopressors and fluid resuscitation 2

Prevention Strategies

High-Risk Patients

• Identify risk factors: older patients (>70 years), heart failure, renal failure, hypoalbuminemia, low body weight 1, 2
• Consider slower transfusion rates in high-risk patients
• Use body weight dosing for RBCs when appropriate 2

Technical Considerations

• Allow blood to reach ambient temperature before transfusion in most clinical situations 1
• Use appropriate administration sets with integral mesh filters (170-200 μm) 1
• Consider leukocyte-depleted blood products to reduce FNHTR risk 3

Monitoring Requirements

• Monitor vital signs before transfusion, 15 minutes after start, and within 60 minutes of completion 1
• For patients experiencing chills, increase monitoring frequency to every 15 minutes until stabilized 2
• Document all reactions and interventions in patient records 2

Important Considerations

• Chills may be the first sign of a more serious transfusion reaction including FNHTR (febrile non-hemolytic transfusion reaction), which occurs in approximately 1% of transfusions 3
• Chills with fever may also indicate bacterial contamination, especially when transfusing through central venous catheters 4
• TACO (transfusion-associated circulatory overload) is now the most common cause of transfusion-related mortality and may present with respiratory symptoms alongside chills 1

Blood warming is particularly important when rapidly transfusing large volumes, especially in vulnerable populations such as neonates, children, elderly patients, and those with cardiac dysfunction 1.