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Febrile nonhemolytic transfusion reactions to platelets
1Department of Pathology, McMaster University, Hamilton, Ontario, Canada.
Current Opinion in Hematology
|November 1, 1995
Summary
Febrile nonhemolytic transfusion reactions may not be immune-mediated but caused by stored platelet product byproducts. New prevention strategies should target these accumulated substances rather than just leukocytes.
Area of Science:
- Transfusion Medicine
- Hematology
- Immunology
Background:
- Febrile nonhemolytic transfusion reactions (FNHTRs) cause patient discomfort and resource utilization.
- Traditionally, FNHTRs were attributed to leukocyte-antibody interactions.
- Current prevention focuses on leukoreduction of blood products.
Purpose of the Study:
- To investigate the cause of FNHTRs, particularly in platelet transfusions.
- To explore alternative mechanisms beyond immune-mediated events.
- To identify potential targets for novel prevention strategies.
Main Methods:
- Review of recent data suggesting non-immune causes for FNHTRs.
- Investigation of biologic response modifiers (BRMs) accumulating in stored platelet products.
- Analysis of potential BRMs like cytokines, histamine, lipids, and complement fragments.
Main Results:
- Evidence suggests FNHTRs in platelet transfusions may result from accumulated BRMs during storage.
- Elevated cytokine levels show a potential association with increased FNHTR risk.
- Concentrations of BRMs increase in stored erythrocyte and platelet products.
Conclusions:
- FNHTRs, especially with platelets, might be caused by accumulated BRMs, not solely immune responses.
- Prevention strategies may need to shift towards reducing BRM production or removal.
- Potential interventions include prestorage leukoreduction, plasma removal, and shorter storage durations.