The Question
A 68-year-old man with a history of myelodysplastic syndrome is admitted for symptomatic anemia. His baseline hemoglobin is 6.5 g/dL. He is initiated on a transfusion of one unit of leukocyte-reduced packed red blood cells. Thirty minutes into the transfusion, the nurse is called to the bedside because the patient has developed shaking chills and feels unwell. His temperature is 101.8°F (38.8°C), up from 99.0°F (37.2°C) pre-transfusion. His blood pressure is 128/76 mmHg, heart rate is 102 beats/minute, and respiratory rate is 18 breaths/minute. His oxygen saturation is 97% on ambient air. Physical examination is notable for rigors, but his lungs are clear to auscultation, and there is no rash, urticaria, or back pain. The transfusion is immediately stopped. A direct antiglobulin test is negative, and a plasma-free hemoglobin level is normal. Which of the following is the most likely cause of this patient's symptoms?
See the answer and explanation below:
Post-Call Recovery Reads
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A
Explanation
Clinical Pearl:
Febrile non-hemolytic transfusion reaction (FNHTR) is a diagnosis of exclusion, characterized by fever and chills during or shortly after a transfusion without evidence of hemolysis, allergic reaction, or volume overload. It is caused by pre-formed cytokines in the blood product.
Explanation:
Hematology
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