Review Question - QID 104914

This patient's presentation of fever and chills 90 minutes after initiation of a blood transfusion is suggestive of a febrile nonhemolytic transfusion reaction. Management of this condition entails immediately stopping the transfusion to rule out more serious conditions followed by administration of an antipyretic (acetaminophen) and resumption of the transfusion after the reaction subsides.

A febrile nonhemolytic transfusion reaction is the most common reaction to blood transfusion. It typically presents 1-6 hours after a blood transfusion with fever (usually T 38-39 C) and chills. This reaction is due to the leaking of cyotkines from donor red blood cells due to long periods of storage. These cytokines result in a mild immunologic reaction causing fever, chills, and malaise. Also, it can be caused by host preformed antibodies to donor white blood cells in the transfusion resulting in a reaction. The fever often resolves spontaneously within 30 minutes even without treatment; however an antipyretic agent is often helpful. This condition does not exhibit any accompanying hemodynamic abnormalities, which differentiates it from other more serious transfusion reactions such as a hemolytic transfusion reaction, bacterial contamination, or transfusion-associated acute lung injury (TRALI).

Incorrect Answers:
Answer 1: Aggressive IV hydration is indicated for the management of an acute hemolytic transfusion reaction to reduce the risk of kidney injury. A hemolytic transfusion reaction would be expected to present with more severe symptoms accompanying the fever, such as tachycardia and/or hypotension.
Answer 3: Diphenhydramine or another antihistamine is appropriate for treatment of pruritis or rash/hives that may occur as an allergic reaction to blood products. This patient is not complaining of itching or a rash.
Answer 4: Initiating supplemental oxygen is the first step in managing transfusion associated circulatory overload or TRALI. This patient does not exhibit shortness of breath or decreased O2 saturation.
Answer 5: Broad spectrum IV antibiotics are indicated when bacterial contamination of blood products leading to sepsis is suspected. Sepsis would be expected to present either with a higher fever or accompanying hypotension and/or tachycardia.