Incidence and Determinants of Febrile Non-Hemolytic Transfusion Reactions in Pediatric Hematology-Oncology Patients
DOI:
https://doi.org/10.58600/eurjther2934Keywords:
febrile non-hemolytic transfusion reaction, hemovigilance, transfusion safety, leukoreduction, pediatrics, red blood cell transfusionAbstract
Objective: Febrile non-hemolytic transfusion reaction (FNHTR) is the most frequent adverse event of red blood cell (RBC) transfusions, even in the era of universal leukoreduction. Pediatric hematology-oncology patients are uniquely susceptible due to repeated transfusions, infections, and immunosuppression. This study aimed to determine the incidence and risk factors of FNHTR in transfused children.
Methods: We retrospectively analyzed all RBC transfusion episodes administered to pediatric hematology-oncology patients (0–18 years) between January 2023 and November 2025 at a tertiary hospital. FNHTR was defined as a ≥1°C temperature rise to ≥38°C during or within four hours post-transfusion, without laboratory evidence of hemolysis. Patient, product, and transfusion related variables were collected from electronic and hemovigilance records. Logistic regression identified independent FNHTR predictors.
Results: Among 1,482 transfusion episodes in 312 patients (median age 8.4 years; 56% male), 64 FNHTRs occurred, corresponding to 4.3 per 100 transfusions (95% CI: 3.2–5.5). FNHTR was less frequent in leukoreduced than non-leukoreduced units (2.9% vs 8.4%; p = 0.01). Products with storage age > 14 days and higher pretransfusion C-reactive protein (CRP) levels were associated with increased FNHTR risk. Multivariable analysis identified lack of leukoreduction (OR 2.41; p = 0.02), product age > 14 days (OR 1.76; p = 0.03), and CRP > 30 mg/L (OR 1.59; p = 0.04) as independent predictors. Premedication had no protective effect.
Conclusion: FNHTR remains the most common transfusion reaction among pediatric hematology-oncology patients.Lack of leukoreduction, older RBC storage, and elevated CRP independently increase risk, while premedication offers no benefit. Universal leukoreduction, use of fresher units, and targeted monitoring of high-risk children may improve transfusion safety.
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