Febrile transfusion reaction: what blood component should be given next?

Reports of febrile, nonhemolytic transfusion reactions (FNHTR) occurring at hospitals served by a regional blood center supplying 99,658 units of blood during 1980 were analyzed to determine if leukocyte-poor red blood cells prepared by the inverted centrifugation technique (LP RBCs) were adequate to prevent subsequent reactions. FNHTR occurred following 0.5% of units transfused. The records of transfusions given to patients who had a FNHTR were reviewed in a subgroup of hospitals. Of 253 such patients, 161 received subsequent transfusions, 140 received red cells or LP RBCs without a reaction. The remaining 21 had a second reaction following transfusion of packed red cells. 12 of the 21 received further red cell transfusions. Only one experienced a third febrile reaction after receiving LP RBCs. We conclude that LP RBCs are adequate to prevent recurrence of FNHTR and question the need for costly saline-washed, leukocyte-poor red blood cells for this purpose.