Febrile oncology pt to transfuse or not? Help!!

debbieGa · Feb 28, 2007

I am a peds heme/onc nurse and on our floor we would have transfused. We would have looked for other s/s of transfusion reactions. With a platelet count of 5 I would have been worried about that. Did the pt have any s/s of bleeding? Has the pt had blood products before, if so have they had a reaction? (if it was their first time I might have not transfused). Also were they in for fever/neut. Where in their nadir are they?

ADN2003 · Feb 28, 2007

he was in for neut, wasnt feverish when he came in but started running a temp that evening, remember this is a med-surg floor.

HemeNP, MSN, RN, NP · Mar 4, 2007

this is a case of febrile neutropenia and pancytopenia maybe coz platelets are down and needed prbc transfusion. pancultures should have been done already and a chest xray as well. identify obvious foci of infection. going back to the question, sometimes the fever doesn't go below 100. I would have called the MD again and inform him about px status. He might have assumed that the fever will go down after the tylenol. Where I work, we would have transfused the pt after all the cultures were done and antibiotics given ASAP (esp for febrile neutropenia).

ADN2003 · Mar 6, 2007

Thanks you guys for your thoughful response. I appreciate it.

littleredmare · Apr 12, 2007

First things that come to mind...with plt of 5 k, pt prob needed the plt asap. take temp, clarify with MD team if ok to transfuse with temp of 100, then get order for ok to transfuse to cya. Was pt on tylenol and still had fever of 100? (not a huge fever) had pt had chemo, when is pt nadir? what was hct, how low? I once had a pt with Hct of 20, temp 100.6, tumor fevers, got order for ok to transfuse with temp of 100.6 (she needed the blood) and transfused her. She turned out fine.

rn-n- 2005 · Apr 17, 2007

On our floor we would have transfused. I would have called Dr and let them know about the temp. We have standing orders for our neutropenic pts like transfuse 2 units PRBC's if hematocrit is equal to or less than 25 and transfuse 1 unit of single donor platelets if plt count is equal to or less than 10 or equal to or less than 20 if febrile. The bone marrow just chews up platelets when they're febrile. These are mostly for our leukemic pts.

Most of the time thses fevers are neutropenic fevers and they are par for the course, unfortunately. Hope this helps.

LittleWeasle44 · Sep 9, 2007

Yeah You should transfuse

hemeoncnursesc · Sep 11, 2007

I work at a major academic university in SC. I've been a hem/onc/BMT RN for 3 years. We ALWAYS TRANSFUSE PLATELETS despite a patient being febrile. Why? FEVERS EAT UP PLATELETS. We wouldn't have transfused PRBCs with a fever >101.5.

Lainee · Oct 12, 2007

Platelets of 5 K? as long as the fever was worked up, yes I'd transfuse the platelets. PRBC depends on the hgb.

bonodonnaonaroll · Oct 14, 2007

I've often wondered what is meant by platlets being "chewed up" during fevers. Why would more platlets be destroyed during a febrile episode?

Thanks for any answers.

Julie

holdensjane · Jan 26, 2008

i'm new to bmt and there's so much i don't know. can someone please explain the reasons for this, about the eating of the plts, not infusing prbcs for fever but infusing plts? My preceptor also told me something about not giving tylenol because of masking the fever, but i can't remember what the conditions were again. She also gave conditions where it would be ok to give the tylenol can someone please explain. i'm still on orientation