What are the signs of febrile non-hemolytic transfusion reaction and its management?

• A. Fever and chills during or after transfusion; stop transfusion, treat fever with antipyretics, and determine if it can be restarted.
• B. Rash and itching during transfusion; stop transfusion and administer antihistamines.
• C. Shortness of breath; treat as congestive heart failure.
• D. Hypertension; increase transfusion rate.

Answer: (A)

Fever with or without chills during or shortly after a transfusion is the hallmark of febrile non-hemolytic transfusion reaction. This reaction arises from recipient antibodies reacting to donor white blood cells or the inflammatory cytokines present in the transfused product. The most important step is to stop the transfusion and assess the patient to rule out more serious reactions, such as acute hemolysis or transfusion-related lung injury. After stopping the transfusion, treat the fever with an antipyretic like acetaminophen and monitor the patient closely, including vital signs and urine for signs of hemolysis. If the patient stabilizes and there is no evidence of ongoing hemolysis or instability, the transfusion can be restarted with careful monitoring or completed with a plan for future precautions. In the future, using leukoreduced blood products can help reduce the risk of FNHTR. Other transfusion reactions present differently—for example, rash and itching point to an allergic reaction, shortness of breath suggests TRALI or anaphylaxis—so the management differs accordingly.