Fever During Transfusion
Fever, typically described in texts as an increased temperature of 1 degree C or 2 degrees F, is one of the earliest and most reliable signs of an acute hemolytic transfusion reaction.
Fever is reported to occur in over 80% of these reactions.
In fact, in many cases, fever alone is the only finding! Therefore, the unexplained onset of a fever during transfusion should always be taken seriously!! Please, I beg you, never let me hear you trying to make the indefensible argument that you can tell the fever of a benign reaction from a fever of acute hemolysis clinically. I hear this all the time from interns and residents, but I tell them the same thing I tell senior physicians whose abilities I respect enormously, and who certainly know more and have seen far more than I have: At the point where you can make a difference, you can not tell a benign fever from the fever of acute hemolysis! Now, after the reaction is well-established and the patient has crashed and burned, the janitor at your hospital can make that diagnosis! The idea is to intervene before you get to that point.
The other thing that makes me crazy is the blood bank resident who makes a statement along these lines: "The Blood Bank called about Mr. Johnson, whose temperature increased 1 degree F during his transfusion. Since it wasn't a 2 degree increase, I told them to go ahead and finish the transfusion." Now, you will read in many places that a 2 degree temperature increase (or 1 degree C) is almost the definition of a transfusion reaction. That's technically true (for a febrile nonhemolytic reaction), but that doesn't mean that an increase of less than 2 degrees is automatically insignificant! Treat all temperature elevations seriously, and if you decide that you don't want to work the patient up for a reaction, make sure that you have a darn good reason not to. I'll be honest, though: I'm not good enough to tell with certainty, so in most instances, if a clinician or nurse calls me with a temperature increase in a transfused patient, I will do a reaction workup.