What is a febrile transfusion reaction?
Nov 24, 2025
Source: Cainiu Health
Dr. Wang Lei
Introduction
In general, febrile reactions following blood transfusion may be caused by factors such as rapid transfusion rate, non-specific body responses, non-hemolytic febrile reactions, bacterial contamination of blood products, or transfusion-associated graft-versus-host disease. It is recommended to seek timely medical attention, identify the underlying cause, and receive symptomatic treatment under a doctor's guidance. Prior to transfusion, donor and recipient information must be carefully verified, and blood storage conditions should be strictly controlled.
Generally, febrile reactions during blood transfusion may be caused by factors such as too rapid transfusion rate, non-specific body response, non-hemolytic febrile reaction, bacterial contamination of blood products, or transfusion-associated graft-versus-host disease. It is recommended to seek medical attention promptly, identify the underlying cause, and receive symptomatic treatment under a doctor's guidance. Specific analyses are as follows:
1. Rapid transfusion rate: Infusing a large volume of blood within a short time increases circulatory load and stimulates the body, leading to fever. Immediately slow the transfusion rate to 1–2 mL per minute, closely monitor body temperature and heart rate, and adjust the rate cautiously after symptoms subside.
2. Non-specific body response: Recipients may be sensitive to components in the blood such as white blood cells or platelets, triggering an immune response and fever. Using a leukocyte filter before transfusion to remove most white blood cells can help prevent this. For mild fever, physical cooling with lukewarm water sponge baths is usually sufficient.
3. Non-hemolytic febrile reaction: The most common cause, occurring when antibodies in the recipient react with donor blood cell antigens, resulting in fever and chills during or within 1–2 hours after transfusion. Patients may take medications such as acetaminophen tablets, ibuprofen sustained-release capsules, or enteric-coated aspirin tablets as directed by a physician, and transfusion should be temporarily halted for observation.
4. Bacterial contamination of blood products: Improper storage or handling can lead to bacterial contamination of blood, causing infectious fever upon transfusion, often accompanied by chills and risk of shock. Transfusion must be stopped immediately. Patients should follow medical advice to use antibiotics such as ceftriaxone sodium injection, levofloxacin injection, or piperacillin sodium-tazobactam sodium injection, along with fluid replacement to correct electrolyte imbalances.
5. Transfusion-associated graft-versus-host disease (TA-GVHD): Donor lymphocytes attack the recipient’s tissues, causing fever, rash, diarrhea, and potentially life-threatening complications. Treatment under medical supervision may include cyclosporine soft capsules, methylprednisolone tablets, or tacrolimus capsules. Irradiation of blood products prior to transfusion can effectively prevent this condition.
Prior to transfusion, donor and recipient information must be strictly verified, and blood storage conditions carefully controlled. During transfusion, healthcare providers should closely monitor the recipient's condition and promptly address any abnormalities to minimize the risk of febrile reactions.
