A patient develops fever and chills during a transfusion, with no signs of hemolysis. This best fits which transfusion reaction?

A patient develops fever and chills during a transfusion, with no signs of hemolysis. This best fits which transfusion reaction?

• A. Hemolytic transfusion reaction
• B. Allergic transfusion reaction
• C. Febrile transfusion reaction
• D. TRALI

Answer: (C)

Fever and chills during a transfusion without signs of hemolysis point to a febrile nonhemolytic transfusion reaction. This happens when donor leukocytes or their cytokines trigger the recipient’s immune system, producing fever as a pyrogenic response. It usually begins during the transfusion or within a few hours and lacks evidence of hemolysis, such as hemoglobinuria or a positive direct antiglobulin test. In contrast, a hemolytic reaction would show hemolysis signs (back/flank pain, dark urine, potential hypotension) and lab evidence of destruction of red cells; an allergic reaction typically presents with itching, hives, or wheezing rather than fever; TRALI causes acute respiratory distress and hypoxemia from noncardiogenic pulmonary edema within hours.

Fever and chills during a transfusion without signs of hemolysis point to a febrile nonhemolytic transfusion reaction. This happens when donor leukocytes or their cytokines trigger the recipient’s immune system, producing fever as a pyrogenic response. It usually begins during the transfusion or within a few hours and lacks evidence of hemolysis, such as hemoglobinuria or a positive direct antiglobulin test.

In contrast, a hemolytic reaction would show hemolysis signs (back/flank pain, dark urine, potential hypotension) and lab evidence of destruction of red cells; an allergic reaction typically presents with itching, hives, or wheezing rather than fever; TRALI causes acute respiratory distress and hypoxemia from noncardiogenic pulmonary edema within hours.