If a fever during transfusion occurs but there is no evidence of hemolysis after stopping the transfusion, what is the recommended course?

• A. Continue the transfusion with antipyretics
• B. Stop completely and discard remaining units
• C. Switch to leukoreduced blood
• D. Administer steroids

Answer: (A)

Fever during a transfusion without signs of hemolysis points to a febrile nonhemolytic transfusion reaction. This happens mainly from cytokines in the donor blood or a mild recipient immune response and is usually self-limited and not life-threatening.

If the patient remains stable and there’s no evidence of hemolysis or other complications, the recommended course is to treat the fever with an antipyretic and continue the transfusion, closely watching for any new or worsening symptoms. Restarting and completing the unit is appropriate once the fever abates, since the transfusion is still needed.

Leukoreduced blood can be considered in future transfusions to reduce the likelihood of FNHTR, but that is a preventive step rather than the immediate response to the current event. Steroids are not routinely used for FNHTR, and completely stopping and discarding all remaining units is reserved for more concerning reactions (such as suspected hemolysis, sepsis, or severe instability).