Can a blood transfusion be given to a patient with a low-grade fever (temperature of 101.2 degrees Fahrenheit)?

Blood Transfusion in a Patient with Fever (101.2°F)

Blood transfusion should not be given to a patient with a fever of 101.2°F (38.4°C) until the cause of fever is investigated and addressed, as fever may indicate an infection or other condition that could be exacerbated by transfusion. 1, 2

Rationale for Withholding Transfusion

• Fever (temperature ≥38°C) during or within 4 hours after transfusion is a key diagnostic criterion for febrile non-hemolytic transfusion reactions (FNHTR), making it difficult to distinguish between pre-existing fever and a transfusion reaction 3
• Transfusion-associated circulatory overload (TACO) is now the most common cause of transfusion-related mortality and major morbidity, and fever may mask early symptoms of serious transfusion reactions 1
• A fever may indicate an underlying infection that should be diagnosed and treated before proceeding with transfusion 4
• Fever could be a sign of sepsis, and transfusing a patient with undiagnosed sepsis could worsen their condition 1

Recommended Approach

Step 1: Investigate the Cause of Fever

• Perform a chest radiograph as recommended for patients who develop fever during ICU stay 1
• Collect blood cultures to rule out bacteremia before proceeding with transfusion 1
• If the patient has a central venous catheter, collect simultaneous central venous catheter and peripherally drawn blood cultures 1
• For patients who have recently undergone thoracic, abdominal, or pelvic surgery, consider CT if an etiology is not readily identified by initial workup 1

Step 2: Treat the Underlying Cause

• For patient comfort, consider using antipyretics rather than nonpharmacologic methods to reduce body temperature 1
• Address any identified source of infection with appropriate antimicrobial therapy 1

Step 3: Reassess Transfusion Need

• Use a restrictive transfusion strategy (transfuse when Hb < 7 g/dL) for most hemodynamically stable patients 1
• For patients with cardiovascular disease, consider a slightly higher threshold of 8 g/dL 1
• Transfusion decisions should be influenced by symptoms as well as hemoglobin concentration 1

Special Considerations

• If transfusion is deemed absolutely necessary despite fever:
  • Monitor the patient closely for signs of transfusion reactions including dyspnea, tachypnea, pulse, blood pressure, and temperature 1
  • Observations should be completed and recorded before the start of the transfusion (within 60 min), 15 min after the start of each unit, and within 60 min of the end of transfusion 1
  • Use blood warming equipment when transfusing, as rapid transfusion of cold blood to a febrile patient could exacerbate temperature instability 1

Cautions and Contraindications

• Fever may mask early symptoms of serious transfusion reactions, making monitoring more difficult 1, 2
• There have been documented cases of infectious diseases transmitted through blood transfusion that initially presented with fever, including Rocky Mountain spotted fever 5
• Febrile reactions are among the most common transfusion reactions and can be difficult to distinguish from pre-existing fever 3

When Transfusion May Proceed Despite Fever

• In cases of life-threatening hemorrhage where the benefit of immediate transfusion outweighs the risks 1
• When fever is known to be due to the underlying condition requiring transfusion (e.g., certain hematologic disorders) 6
• After appropriate investigation has ruled out active infection and the clinical need for transfusion is urgent 1

Remember that patient monitoring is essential during any transfusion to identify and manage adverse reactions, with particular attention to respiratory rate, which can indicate early symptoms of serious transfusion reactions 1.