Can you administer blood to a patient with hyperthermia (elevated temperature)?

Blood Transfusion in Patients with Elevated Temperature

Blood transfusion can be safely administered to patients with elevated temperature, but the cause of fever should be investigated first unless life-threatening hemorrhage requires immediate transfusion. 1

Clinical Approach Algorithm

Step 1: Assess Clinical Urgency

In life-threatening hemorrhage, proceed with immediate transfusion despite fever - the benefit of transfusion outweighs the risks of delaying for fever workup. 1 In these cases:

• Use rapid infusion devices (6-30 L/h) with integrated blood warming capability 2
• Warm all blood components to 37°C when transfusing ≥500 mL 2
• Monitor closely for transfusion reactions including respiratory rate, pulse, blood pressure, and temperature 1

Step 2: For Non-Emergent Situations - Investigate Fever Source

Before proceeding with transfusion in hemodynamically stable patients, investigate the fever etiology: 1

• Obtain blood cultures (both peripheral and central line if present) to rule out bacteremia 1
• Perform chest radiograph for ICU patients with new fever 1
• Consider CT imaging for post-surgical patients (thoracic, abdominal, or pelvic) if initial workup is unrevealing 1

The rationale for investigation: Fever may indicate sepsis or infection that could be exacerbated by transfusion, and fever can mask early symptoms of serious transfusion reactions such as transfusion-associated circulatory overload (TACO), now the most common cause of transfusion-related mortality. 1

Step 3: Manage Fever While Investigating

• Use antipyretics (acetaminophen) for patient comfort 1, 3
• Adequate fever control helps distinguish pre-existing fever from potential transfusion reactions 3
• If fever persists despite initial antipyretic therapy, adding a second dose is appropriate 3

Step 4: Proceed with Transfusion After Investigation

Once appropriate investigation has ruled out active infection and clinical need is established, transfusion may proceed: 1

• Mild temperature elevation (up to 99.7°F/37.6°C) is not a contraindication to transfusion 4
• Complete observations before transfusion (within 60 min), at 15 minutes after starting each unit, and within 60 minutes of completion 1, 3
• Monitor particularly for dyspnea and tachypnea as early signs of serious transfusion reactions 3

Critical Temperature Management Considerations

The primary temperature concern in transfusion medicine is actually hypothermia, not fever. 4 This is particularly important because:

• Hypothermia (<35°C) is associated with increased mortality, blood loss, and coagulopathy in trauma patients 2, 4
• A 1°C drop in body temperature causes a 10% decrease in coagulation factor function 4
• Hypothermia combined with acidosis creates a synergistic impairment of coagulation 2, 5

Blood Warming Requirements

All blood components should be warmed to 37°C when transfusing volumes ≥500 mL in adults undergoing surgery under general or regional anesthesia. 2, 4

• Use only approved blood warming equipment with visible thermometer and audible warning 2, 4
• Blood warming up to 43-46°C is safe and causes only clinically negligible hemolysis 6
• Greatest benefit comes from warming red cells (stored at 4°C) rather than platelets or FFP 2

Common Pitfalls to Avoid

• Do not delay transfusion in hypotensive/hemorrhaging patients due to mild fever - this represents unnecessary risk 1, 4
• Do not transfuse cold blood rapidly - this worsens coagulopathy and increases mortality 2, 4, 5
• Do not rely solely on caregiver reporting - systematic vital sign documentation identifies more transfusion-associated temperature elevations than clinical reporting alone 7
• Patients with pre-existing fever are more likely to have transfusion-associated temperature elevation - this makes baseline documentation and close monitoring essential 7

Special Population Considerations

For patients with cardiovascular disease, consider a slightly higher hemoglobin threshold (8 g/dL vs 7 g/dL) when making transfusion decisions. 1 For massive hemorrhage with ongoing bleeding, target hemoglobin of 7.0-9.0 g/dL during active resuscitation. 4