From the Guidelines
A blood transfusion should be immediately stopped if a patient develops a fever during the transfusion, as indicated by the most recent and highest quality study 1. If a patient's temperature rises to 38°C (100.4°F) or higher, or increases by 1°C or more from baseline during or shortly after a transfusion, the transfusion should be discontinued and the patient assessed for a transfusion reaction. The IV line should be kept open with normal saline while notifying the physician and blood bank. Vital signs should be monitored closely, and samples from the patient and blood product should be collected for investigation. Fever during transfusion may indicate a serious transfusion reaction such as acute hemolytic transfusion reaction, febrile non-hemolytic transfusion reaction, or bacterial contamination of the blood product. These reactions can range from mild to life-threatening, so prompt action is essential. Treatment may include antipyretics like acetaminophen, but addressing the underlying cause is paramount. The transfusion can only be resumed if a serious reaction has been ruled out and the physician determines it is safe to continue, as suggested by the guidelines from the AAGBI 1 and the American Society of Clinical Oncology 1.
Some key points to consider when managing a patient with a fever during blood transfusion include:
- Monitoring the patient's vital signs closely
- Notifying the physician and blood bank immediately
- Keeping the IV line open with normal saline
- Collecting samples from the patient and blood product for investigation
- Considering the possibility of a serious transfusion reaction and taking prompt action to address it, as recommended by the AABB guidelines 1.
It is essential to prioritize the patient's safety and take a cautious approach when managing a fever during blood transfusion, as the potential consequences of a serious transfusion reaction can be severe.
From the Research
Blood Transfusion and Fever
- Blood transfusions can carry considerable risks, including transfusion reactions and adverse events 2
- Transfusion pyrexia (fever) is an important clinical sign/symptom occurring either as an isolated event or as part of a constellation of signs and symptoms in relation to blood transfusion 3
- The decision to stop a blood transfusion episode on account of fever is often a difficult one, and adequate evaluation remains a challenge for clinicians 3
Management of Transfusion Reactions
- When a reaction is suspected, it is critical to stop the transfusion immediately and report the reaction to the blood bank, as this can affect the patient's outcome 2
- Any symptom occurring within 24 h of a blood transfusion should be considered a transfusion reaction and referred to the hemovigilance reporting system 4
- The initial management of blood transfusion reactions requires early identification, immediate interruption of the transfusion, early consultation of the hematologic and ICU departments, and fluid resuscitation 4
Discontinuation of Blood Transfusion due to Fever
- There is no clear consensus on whether blood transfusion should be discontinued in the event of fever (pyrexia) 3, 4
- However, it is recommended to examine blood cultures from the recipient in all suspected cases of adverse transfusion reaction to determine if the fever is related to the transfusion or not 5
- In some cases, fever during blood transfusion may be a coincidence rather than a causality, and further evaluation is necessary to determine the cause of the fever 5