What is the treatment for post-transfusion fever?

Treatment of Post-Transfusion Fever

For febrile reactions following blood transfusion, intravenous paracetamol is the recommended first-line treatment, with a personalized approach based on the patient's specific symptoms rather than indiscriminate use of steroids or antihistamines. 1

Diagnosis and Initial Management

When fever occurs during or after transfusion:

1. Immediately stop the transfusion and assess for signs of serious transfusion reactions 1
2. Order appropriate diagnostic testing to rule out more serious reactions 1
3. Monitor vital signs including:
   • Respiratory rate (dyspnea and tachypnea are early symptoms of serious reactions)
   • Pulse
   • Blood pressure
   • Temperature 1

Treatment Algorithm

For Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

• First-line treatment: Intravenous paracetamol 1
• Avoid indiscriminate use of steroids as repeated doses may further suppress immunity in immunocompromised patients 1
• Do not routinely administer antihistamines for purely febrile reactions 1

For Allergic Reactions (if urticaria or other allergic symptoms accompany fever)

• Administer antihistamines only 1
• Do not use steroids unless severe reaction

For Severe Reactions or Suspected Anaphylaxis

• Follow local anaphylaxis protocols 1
• Provide respiratory and circulatory support as needed

Distinguishing Between Reaction Types

It's crucial to distinguish between different types of transfusion reactions:

• Febrile Non-Hemolytic Transfusion Reaction (FNHTR): Fever (≥38°C or increase >1°C from baseline), chills, rigors without evidence of hemolysis 2
• Transfusion-Related Acute Lung Injury (TRALI): Acute respiratory distress, hypoxemia, bilateral pulmonary infiltrates within 6 hours of transfusion 3
• Transfusion-Associated Circulatory Overload (TACO): Respiratory distress, tachycardia, hypertension, evidence of fluid overload 1, 3
• Hemolytic Reaction: Hypotension, tachycardia, hemoglobinuria, microvascular bleeding 1

Special Considerations

• Rule out coincidental infection: Sometimes fever during transfusion may be coincidental rather than causative. Consider obtaining blood cultures if infection is suspected 4
• For recurrent febrile reactions: Consider using saline-washed, post-storage leukocyte-reduced platelets for future transfusions, which can reduce reaction frequency from 20% to 0.6% 5
• Risk factors for febrile reactions: Female donors, high leukocyte count in donor blood, multiple previous transfusions, and primary hematologic or malignant disease 2, 6

Prevention of Future Reactions

• Leukocyte reduction significantly decreases the incidence of febrile reactions 2
• Slower transfusion rates for patients with history of reactions 1
• Monitor closely for signs of transfusion reactions, especially in high-risk patients 1

Key Pitfalls to Avoid

• Do not continue transfusion when fever develops - stop and investigate 1
• Do not use steroids routinely for simple febrile reactions 1
• Do not miss signs of more serious reactions that may initially present as fever (TRALI, hemolytic reactions, bacterial contamination) 1, 3
• Do not assume all post-transfusion fevers are transfusion reactions - consider coincidental infections 4