Saud sharyan A FEBRILE REACTION IN A WOMAN WITH ANTI-Fyb Case study by Jim Perkins
1) What is the differential diagnosis of fever at the time of transfusion?
If a patient experiences fever after or during having a blood transfusion, it could be caused by the blood transfusion itself or the patient has an illness, which is causing the fever. It is not uncommon for a patient undergoing a blood transfusion to experience a fever due to febrile non-hemolytic reaction (FNHTR) caused by the effect of many different pathogens. Patients whose antibodies react with a donor’s white blood cells present febrile non-hemolytic reactions as well. This is not an uncommon medical situation and has been studied for a long time already. Some scientific studies have shown that certain type of thalassemic patients often get a fever when they get a blood transfusion due to their antibodies working against HLA. As the donor’s white blood cells are destroyed, cytokines are released causing inflammation. Other scientific studies have also shown that these cytokines, once they enter the circulatory system, have the potential to cause a fever. Fever and hypotension can also be caused by the bacterial contamination of the unit used to carry out the blood transfusion. In severe lung injuries, respiratory symptoms often mask the presence of a fever, which is very common during these cases.