Febrile Nonhemolytic Reactions
PREVENTION: In a previous section, I discussed the evolving understanding of the mechanisms of Febrile Nonhemolytic Transfusion Reactions
As mentioned there, we have identified at least two different ways these reactions occur.
It should not surprise you, then, to know that the prevention of FNH's is not likely to be successful with one strategy, either.
Before I go too far into the well-defined and accepted ways to prevent these reactions, I would be remiss if I didn't mention one of my favorite strategies, which is simple, tried, and true. Premedicating patients 30 minutes or so before the transfusion with acetaminophen is something that I recommend almost without reservation, because it may help block the clinical manifestations of an FNH. For more on this, read the section on premedication.
OK, now on to the fun stuff! Preventing the FNH revolves around the strategy of leukocyte reduction, but the timing of the leukocyte reduction is critical, depending on the mechanism of the FNH (forgive me, I'm beginning to sound like a techno-nerd; hang in there and I'll make sense in a minute, I promise!). What I'm saying is this: Some febrile reactions will be prevented by pretransfusion leukocyte reduction, and some by prestorage leukocyte reduction. Let's hit them both.
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