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?”
Other posts from Abdul Mannan on Hemostasis Today.
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May 13, 2026, 17:38Rohit Sankar J. Snscphysio: Recognizing the Clot Before It Becomes Life-Threatening
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May 13, 2026, 16:41Seema Dawood: When Elevated Platelets Signal a Myeloproliferative Neoplasm
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May 13, 2026, 16:38Kari Tikkinen: Defining Thromboprophylaxis in MIBC Neoadjuvant Care
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May 13, 2026, 16:28Nadia Tarhini: Evaluating the Risk of Recurrent Thrombosis in Children with ALL
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May 13, 2026, 16:01Sifat Jubaira: When Low MCV Meets High Platelets
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May 13, 2026, 15:58Aktham El-rekaby: Immunothrombosis in Acute Ischaemic Stroke
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May 13, 2026, 15:49Alison Dougall: Oral Health and Cardiovascular Risk in Bleeding Disorders
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May 13, 2026, 15:38International Journal of Stroke: Oral Anticoagulants and DOAC–Antiplatelet Therapy Are Associated with Increased Major Bleeding Risk
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May 13, 2026, 15:19Papa Heme։ Causes of Isolated Prolonged aPTT Without Bleeding