Misoprostol administration mimicking a febrile transfusion reaction

Misoprostol, a synthetic prostaglandin E1 analogue, is widely used in obstetrics for its uterotonic properties. It is known to cause thermogenic side effects, a fact well-recognized in obstetrics but less familiar in transfusion medicine.

Data were collected through chart review, including temperature recordings, serologic findings, and blood culture results.

This case report describes a postpartum temperature spike to 39.2°C in a G1P0 female who received a red cell transfusion shortly after administration of misoprostol. Serologic workup for transfusion reaction showed no abnormalities, and blood cultures of both the patient and donor were negative for growth. Febrile nonhemolytic transfusion reaction (FNHTR) remained in the differential, however, the fever was attributed to misoprostol's thermogenic effect rather than a transfusion reaction.

Increased awareness of misoprostol's thermogenic effects in transfusion medicine may improve differential diagnosis, reduce unnecessary testing, and enhance patient satisfaction by avoiding unwarranted concerns regarding transfusion reactions.