Febrile Non Haemolytic Transfusion Reactions

Febrile non haemolytic transfusion reactions (FNHTR) has been defined as a 1 – 2 degree Celsius increase in body temperature taking place either during or soon after a blood transfusion. This may be accompanied by chills and rigors. Standard practice is for a diagnosis of FNHTR to only be made after other causes more likely causes of fever such as sepsis and haemolysis have been specifically excluded.

 

Two possible causes of FNHTR have been described:

  1. HLA antibodies in the patient binding to their cognate antigens on white cells in the transfused blood product
  2. Leucocyte derived cytokines released into the transfused product during storage as well as cytokines released by the recipient as a result of the transfusion

 

The incidence of HLA antibody induced FNHTR has decreased in the leucodepletion era. H&I laboratory investigation of FNHTR includes HLA class I and II antibody testing of the patient. HLA antibody screening and identification has historically been by cell based techniques such as the complement dependent cytotoxicity (CDC) assay or by cell based flowcytometric assays. Currently however, most HLA antibody testing in the UK is by the solid phase Luminex bead based assays.

 

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