I Thought a Blood Transfusion Would Make Me Feel Better

Leonard I. Boral, MD, MBA; Duncan C. MacIvor, MD; Julie A. Ribes, MD, PhD


March 28, 2011

In This Article

Clinical History

A 60-year-old man undergoing chemotherapy for acute myelogenous leukemia was receiving a red blood cell (RBC) transfusion because his hemoglobin had dropped to 7.5 g/dL. He had received 6 units of RBCs and 3 units of platelets during the preceding 4 months with no apparent incident. One hour after the transfusion began, with about half the unit infused, the patient became anxious, mildly short of breath, and a fever of 101.9°F developed. The transfusion was stopped at the onset of symptoms and the intravenous (IV) line was kept open with normal saline at 10 drops/minute. The RBC unit was sent to the blood bank with posttransfusion patient specimens for a transfusion reaction workup.

The patient's vital signs prior to the start of the transfusion and at the time of the reaction are outlined in Table 1.

Table 2 shows the results of the transfusion reaction laboratory workup.

Table 1. Vital Signs

Vital Signs Pretransfusion Time of Reaction
Blood pressure 120/70 mm Hg 150/90 mm Hg
Pulse 80/min 105/min
Respirations 12/min 16/min
Oral temperature 98.9°F 101.9°F

Table 2. Transfusion Reaction Laboratory Workup Results

Test Pretransfusion Posttransfusion
Direct antiglobulin test Negative Negative
Plasma hemolysis Negative Negative
ABO/Rh A+ A+
Clerical check OK OK

What is the differential diagnosis for this patient's transfusion-associated fever? What is the most likely diagnosis considering the medical history and the transfusion reaction laboratory workup results?


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