To prevent febrile non-hemolytic transfusion reactions, which RBC preparation is recommended?

• A. Irradiated leukocyte RBCs
• B. Washed RBCs
• C. Platelet transfusion
• D. Fresh RBCs

Answer: (A)

Febrile nonhemolytic transfusion reactions occur mainly from donor leukocytes releasing pyrogenic cytokines or from recipient antibodies reacting with donor leukocyte antigens. To prevent these reactions, inactivate or remove donor leukocytes in the transfused unit. Irradiation of leukocyte-containing red blood cells inactivates donor T-lymphocytes, preventing their proliferation and their ability to produce or release fever-causing cytokines. This approach also lowers the risk of transfusion-associated graft-versus-host disease in susceptible patients. Washed red cells can help with reactions related to plasma proteins (like allergic reactions) and may reduce some febrile symptoms, but irradiation directly targets the leukocyte-driven pathway implicated in FNHTR. Platelet transfusion and using fresh red cells do not specifically address the leukocyte-mediated cytokine mechanism responsible for febrile nonhemolytic reactions, so they’re not the preferred strategy for this purpose.