Criteria used for fever as a sign/symptom of a transfusion reaction
A colleague in Maine is concerned about the criteria used for fever as a sign/symptom of a transfusion reaction. She would like to know if colleagues use an absolute temperature above which a transfusion reaction is considered, as well as an absolute increase of at least 1C. Presently, their current policy is as follows: fever (not defined) exceeding 1C above baseline.
The following comments have been received in response:
ADDENDA May 6, 2010
- A transfusion service medical director in Illinois reports that the following is an excerpt from the blood administration policy in force at his academic medical center:
Temperature increase: If the patient has a temperature increase of greater than 1.8°F (1°C) to a temperature above 99.5°F (37.5°C), OR has chills or rigors regardless of the temperature, then a transfusion reaction should be considered.
This is meant to exclude innocuous patient warm-ups such as coming out of a cold operating room. Before they added this provision, they reviewed several reports of temperature rises that did not go above 37.5C, and did not find any clinical concerns.
ADDENDA May 16, 2010
- A transfusion medicine physician in Virginia reports that at his academic medical center they use a 1 degree C increase in temperature regardless of the starting temperature. He comments that while almost all febrile reactions are benign, the possibility that it is a harbinger of a life-threatening reaction prompts them to want to evaluate such a situation as soon as this increase is reached without consideration of the pre-reaction temperature.
ADDENDA May 18, 2010
- A hospital in the MidWest uses the United States Biovigilance Network definitions for febrile transfusion which can be found on the CDC website.
- A colleague in Vermont reports that at his hospital they use only a 1 degree centigrade rise above the pre-transfusion temperature (relative change) as critera for a febrile reaction that requires an evaluation, and not an absolute value.
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