A 58-year-old post-operative patient receives a pooled platelet transfusion. One hour later his temperature has risen by 1.2 degrees Celsius with rigors. There is no haemoglobinuria, plasma is not pink, and the direct antiglobulin test is negative. Renal function is unchanged. What is the mechanism of this reaction?

• A ABO-incompatible red cells lysing in the circulation
• B Passive transfer of IgA against recipient IgA deficiency
• C Accumulated cytokines released by leucocytes during storage of the component ✓
• D Bacterial growth in the platelet unit

Explanation

This is a febrile non-haemolytic transfusion reaction. Platelets are stored at room temperature, allowing cytokines such as IL-1, IL-6 and TNF-alpha to accumulate in the unit during storage; these mediate fever. The negative direct antiglobulin test and absence of haemoglobinuria exclude haemolysis. Bacterial contamination also causes fever but typically with profound hypotension and sepsis picture, so it must be considered but is less consistent here. Management is stopping the transfusion, antipyretics, and excluding haemolysis and sepsis.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.