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Abdul Mannan: Recognition and Management of Febrile Non-Haemolytic Transfusion Reactions in Clinical Practice
Abdul Mannan/LinkedIn
Apr 19, 2026, 09:35

Abdul Mannan: Recognition and Management of Febrile Non-Haemolytic Transfusion Reactions in Clinical Practice

Abdul Mannan, Consultant Hematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:

“FNHTR is the most common transfusion reaction — but its real danger is that it can mimic the early signs of a haemolytic transfusion reaction (HTR), which is life-threatening.

The hook should create that tension: common but terrifying until proven otherwise.

Fever during a blood transfusion.

Every junior doctor freezes.

Is this dangerous?

Do I stop the blood?

Is my patient haemolysing?

Most of the time? It’s FNHTR.

But you can’t assume that.

Here’s the framework:

What’s happening:

  • Recipient antibodies attack donor white cells
  • Or cytokines accumulate in the stored bag
  • Result: fever ≥38°C or a ≥1°C rise, with chills and rigors

The diagnosis is by exclusion:

  • No hypotension
  • No respiratory distress
  • No haemolysis

If ANY of these are present — think harder.

What to do:

  • STOP the transfusion immediately
  • Send blood for labs (FBC, DAT, repeat group and screen)
  • Give paracetamol
  • Only RESTART slowly once you’ve ruled out something serious

Prevention:

  • Leucodepletion of blood components
  • All UK blood products are now leucodepleted — this has cut FNHTR rates dramatically

The 2023 SHOT report still lists FNHTR as the most reported transfusion complication in the UK.

Common doesn’t mean trivial.

When you stop that bag — you’re not overreacting.

You’re doing exactly the right thing.

What’s the most challenging transfusion reaction you’ve managed?”Abdul Mannan: Recognition and Management of Febrile Non-Haemolytic Transfusion Reactions in Clinical Practice

Other posts from Abdul Mannan on Hemostasis Today.

Abdul Mannan FNHTR Haemolytic Transfusion Reaction Health Hematology Hemostasis News Hemostasis Today HTR Medicine
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