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 we didn't discuss one of the most commonly accepted methods of prevention of these reactions. Premedicating patients 30 minutes or so before the transfusion with acetaminophen is something that I have recommended almost without reservation for years, because I (like most blood bankers) believed that it would help block the clinical manifestations of an FNH. However, more recent data shows premedication to be much less effective than we thought. For more on this, read the section on premedication.
OK, so it appears that it might not be effective to just manage the effects of an FNH; instead, we need to discuss how to actually manipulate the blood product in order to keep these reactions from occurring. This manipulation primarily revolves around the strategy of leukocyte reduction, but the timing of the leukocyte reduction is critical, depending on the mechanism of the FNH (hang in there and it will make more sense in a minute, I promise!). What I'm saying is this: Some febrile reactions can be prevented by leukocyte reduction done just before transfusion, while just about all febrile reactions will be prevented by leukocyte reduction done before the product is in storage. Let's discuss them both.
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