Transfusing febrile pt.'s

[Hooligan]

Hello Everyone!

I have a quick question...what is your hospital's policy on transfusing pt's who have a pre-existing fever. I had a pt. last night with a large necrotic abdominal abcess. her H& H was 8.2 and 22....something and she's scheduled to go for an I&D of the wound today. She had a fever while the infectious disease Dr. was there and I asked about getting an order for Tylenol or Motrin for the fever. The I/D Dr. didn't want to write an order for antipyretics because he felt the fever was therapeutic and only wrote the order for pt. c/o aches and pains. In this same group of orders, he wrote for the pt. to get her 1st two doses of antipyretics 1st then the transfuse the 2 units of blood. After the abx went in, the pt's temp was 102.8. I called the primary doctor who ordered the blood originally, and let notified him of the fever. He said to give 2 tylenol and go ahead with the transfusion. When I told him what the I/D dr. said about the fever and not wanting to medicate it he said ok. then go ahead and start the transfusion. I decided to give the Tylenol first for pt. c/o aches and pains and proceeded to hang the blood. During the transfusion her temp started to come down and at the 1 hour mark she was 101.1. So what is your hospital's policy on hanging blood on pt.'s with a fever?

~Bean

[owensmommy]

We just have to get a doc's order that it's okay to transfuse. And we usually would then premed with Tylenol.

[RN1982]

Same here.

[RN1989]

Get the doc's ok for anyone with a temp over 101. They usually order tylenol and sometimes prednisone.

[husker_rn, RN]

I have had docs order Tylenol and Benadryl before hanging blood.

[BrnEyedGirl, BSN, MSN, RN, APRN]

We hang blood on febrile pts,.it usually brings down their temps since it's cold! Now if pt starts with temp of 102 and durring the first unit spikes 103 then we treat it as a reaction.

[Blee O'Myacin, BSN, RN]

Our facility policy is that we hold a transfusion pending MD order if the temp spikes 2 degrees F over baseline.

I would be comfortable with hanging the blood on a febrile patient, but would document speaking with the MD first, so that all parties are aware that the patient is febrile and that the blood should be given anyway. Seems like the benefits to this patient outweigh the risk. Having a fever doesn't predispose a patient to having a transfusion reaction, it just makes it more difficult to determine if they are having one or just having a natural temperature elevation.

Since we run blood over 4 hours, I would expect a spike towards the end of transfusing a febrile patient if you are only giving 650mg of tylenol. I'd still notify the MD, and would be monitoring this patient closer than a afebrile patient, but wouldn't worry about a transfusion reaction unless additional symptoms were present.

Blee