TRANSFUSION & FEVER

Hello Canadian_Family,

Thanks for your nice reply.Yesterday my baby got her transfusion and again she is now suffering from fever.

Hello Andy,

This time I also gave her Adryl 5 ml before transfusion and taken time 4 hrs. Bcoz last time transfusion was completed early so this time we take time.But no result.

The same donor donate her earlier then she was ok but now why fever came? Last 3 transfusions my baby suffered by fever and always it is 101 to 103.

Last 3 times after complete the transfusions fever came with chills and shaking.Doctor advice for injection (forgot the name) but not confirm about fever.

Please help me.....

Is the blood being filtered?

Dear lokhi maa

My baby hardik had also gone through these situations..... And when we talk to doc they advice us to take the blood of SAGM(already filtered by removing WBC during storage)....as I don't have donors so use donated blood.....and to use filter at transfusion time.....and the results are positive....he doesn't get fever....

As u have available donors......just try to talk to blood bank to remove excess WBC ,Platelets.... And all which are not required and contribute in developing antibodies and..... as baby 's body only need RBC so it is safe to remove excess part....and then use leukocytes filter..... I think u will surely succeed

Praying for u
Neha

Hello Andy and Hardik,

Thanks for your reply and sharing your experience.

We just only removed Platelets and give her packed cell.I have no idea about removing WBC.I will sure discuss about it.

Andy can't understand by filtered...WBC and Platelets are not same ?

Dear lokhi maa.....

No WBC and Platelets are not same,they are two different things having different functions. WBC work as guard and Platelets have healing properties..

I think Andy also means of using leukocytes filter....or called bed side filter
Or may be he is talking about NAT tested blood


Leukocytes are wbc only according to my knowledge..... WBC guard our body against foreign particles....and if we introduced more WBC in body through transfusion.....more antibodies will be produced to guard our body by breaking more RBC as thalassemic RBC are of irregular shape not recognized by wbc so ....results fatal.....thus it is better to use leukocytes filter...

I dont know much and Better explanation can be given by Andy only......

Waiting for Andy's reply
Neha

Lokkhi, yes I am talking about a filter that goes in the line when the child is transfused. The filter blocks white cells and platelets from getting through. If the blood has not been pre-filtered, this is necessary. Even with filters, occasionally, bits of white cells or platelets get through that can still cause a reaction, but this doesn't happen often.

Thanks Hardik and Andy.What a lot of experiences you have  Its great..

I will discuss about removing white cell but don't know will it be possible or not 

Hello Andy,

Next Friday my baby will take her transfusion and we have already discuss about removing WBC and Platelets.But they confirm us in the packed cell there is nothing except RBC.They remove all like WBC,Platelets and other elements also.

My baby always take fresh blood and we give her Adryl before transfusion.But from last few transfusions she suffered by fever after complete or ending moment of transfusion which are not in earlier.

We also mark that which donor earlier donate her then she was normal but now suffer fever. Whats the reason and what to do 

They are correct in saying that packed cell contains only RBC.

In transfusion medicine, packed red blood cells (sometimes called stored packed red blood cells or simply packed cells) are red blood cells (RBC, also called erythrocytes) that have been collected, processed, and stored in bags as blood product units available for blood transfusion. The whole blood is processed to remove WBC, Platelets from RBC.

Now what we will do for avoid fever?

Lokkhi,

It really depends on how the red blood cells are prepared. If the red cells are simply separated by centrifuge, fragments of white cells will still be there. If the red cells are leukocyte depleted, then they have been filtered to remove the white cell fragments. If this has been done, the only treatment is to give an analgesic like ibuprofen with the transfusion.

Dear Andy,

Whats the effect and how much harmful fever after transfusion for health?As Adryl not worked earlier so may I leave it or continue to my baby?

As long as the fever is low, <102°, then there is no effect from the fever. Many patients deal with this by taking an analgesic.

Hello Andy,

Thanks for your reply.

Last Friday was my babies transfusion day and a very very bad experience for me.

This time donor was a new person and we start transfusion after giving her Adyrl and Napa (Fever medicine) 5 ml respectively.But only half an hour fever came and her whole body shaking rapidly.Fever was low 100 but shaking was too much.My babies hand and throat was shaking rapidly and continue it 15 to 20 minutes.Its really horrible.

Doctor gave her fever suppository and said to stop transfusion for some times and a wet towel keep on her forehead up to finish transfusion. After 1 hr temperature reduce and start again transfusion 8 drops in a minute.At last we have finished the horrible transfusion after 7 hrs as 12 drops in a minute.
We came home with low fever in evening and gave her again suppository and fever medicine timely but in mid night again shaking raised and stay 10 minutes.This time shaking done very much rapidly than earlier.

Last 5/6 times fever came after transfusion but now to much early though giving her Napa and Adyrl also.We marked that the fever stay minimum 1 day and not reduce by any medicine.We finished her transfusion maximum in evening and next day up to noon it stay.Then she recover normally.

Now my baby is fine..

Whats the reason for shaking ?? I don't want to face the same situation in next time.

Lokkhi,

It is standard practice to stop the transfusion once the child started to shake. This is most likely what is called a febrile non-hemolytic transfusion reaction. Again, filtered blood is most important, but this can still occur in very small percentages of transfusions, even when the red cells have been filtered. It is not considered to be a serious issue, but transfusion is stopped unless the cause of the reaction has been easily identified. It can be resumed at a slow rate when other types of transfusion reactions are ruled out.

This link describes this type of reaction and what to do about it.

http://www.transfusion.com.au/adverse_transfusion_reactions/febrile_non-haemolytic

Febrile non-haemolytic transfusion reactions (FNHTR)

This is an acute (<24 hours), immunological transfusion reaction.
 

When to suspect this adverse reaction?

Patients present with an unexpected temperature rise (≥38ºC or ≥1ºC above baseline, if baseline ≥37ºC) during or shortly after transfusion. This is usually an isolated finding. Occasionally the fever is accompanied by chills.

Chills, rigors, increased respiratory rate, change in blood pressure, anxiety and a headache may accompany this reaction but occur in several more serious transfusion reactions also, the most serious being acute haemolytic reaction, transfusion associated sepsis and TRALI. FNHTR is a diagnosis of exclusion.

This occurs in 0.1% to 1% of transfusions with leucocyte depletion.(1)
 

Usual causes?

Cytokine accumulation during storage of cellular components (especially in platelet units) is thought to be the most common event leading to symptoms of FNHTRs. Cytokines are released by white cells and pre-storage leucodepletion has reduced this risk.

FNHTR is also caused by the presence of recipient antibodies (raised as a result of previous transfusions or pregnancies) reacting to donor human leucocyte antigens (HLA) or other antigens. These antigens are present on donor lymphocytes, granulocytes, or platelets.
 

Investigation

Clinically assess the transfused patient for fever, chills, rigors and headache.

Acute haemolytic reaction may need exclusion.

Direct antiglobulin test (DAT), blood count and repeat ABO grouping may be indicated. Consider investigations for transfusion associated sepsis.

In patients with repeated FNHTR, investigation for HLA antibodies may be useful.
 

What to do?

Stop transfusion immediately and follow other steps for managing suspected transfusion reactions.

Treat the fever with an antipyretic. However, avoid aspirin in thrombocytopenic and paediatric patients.

Consider and exclude other causes, as fever alone may be the first manifestation of a life threatening reaction.

Rule out acute haemolytic reaction, transfusion associated sepsis and Transfusion-related acute lung injury (TRALI).

Recommencement of the transfusion, at a slow rate, is possible if other causes of a fever have been excluded.
 

References

Roback JD (ed). Non-infectious complications of blood transfusion. Chapter 27, AABB Technical Manual, 17th edition. AABB, Bethesda, 2011.
Popovsky M (ed). Transfusion reactions, 3rd edition. AABB Press, Bethesda, 2007.
Callum JL, Lin Y, Pinkerton PH, Karkouti K, Pendergrast JM, Robitaile N et al. Chapter 5, Transfusion Reactions. Bloody Easy 3: Blood Transfusions, Blood Alternatives and Transfusion Reactions: A Guide to Transfusion Medicine, 3rd edition. Canada: Ontario Regional Blood Coordinating Network, 2011. [cited 2012 Sep 13]. Available from: http://transfusionontario.org/en/.
- See more at: http://www.transfusion.com.au/adverse_transfusion_reactions/febrile_non-haemolytic#sthash.X1WNlBiz.dpuf