A 62-year-old man develops a fever of 38.8°C, chills, and mild hypotension 90 minutes into a packed red blood cell transfusion following elective hip replacement. There is no evidence of hemolysis on direct antiglobulin test and no new infiltrate on chest X-ray. What is the most common cause of this presentation?

• A Acute hemolytic transfusion reaction due to ABO incompatibility
• B Transfusion-related acute lung injury (TRALI) due to donor HLA antibodies
• C Febrile non-hemolytic transfusion reaction due to donor leukocyte cytokines ✓
• D Bacterial contamination of the blood product

Explanation

Febrile non-hemolytic transfusion reaction (FNHTR) is the most common transfusion reaction, occurring in approximately 1 in 300 transfusions of packed red cells. It is caused by cytokines released from donor leukocytes and is characterized by temperature rise of ≥1°B during or shortly after transfusion without evidence of hemolysis. TRALI presents with bilateral pulmonary infiltrates. Hemolysis would show a positive DAT.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.