American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment for a febrile nonhemolytic transfusion reaction?

1. Administration of epinephrine

2. Transfusion discontinuation and acetaminophen for fever

3. Resuming transfusion after symptoms resolve

4. Immediate blood culture

The correct answer is: Transfusion discontinuation and acetaminophen for fever

In a febrile nonhemolytic transfusion reaction, the appropriate treatment involves discontinuing the transfusion and managing the fever. This type of reaction is typically due to the recipient's immune response to white blood cell cytokines or other components in the transfused blood product, rather than any direct harm caused by elements within the transfused blood itself. The first step in managing this reaction is to stop the transfusion immediately to prevent further exposure to the blood components that are triggering the febrile response. Following this, acetaminophen can be administered to help reduce the fever. This approach is clinically supported because febrile nonhemolytic reactions are generally self-limiting, and symptomatic treatment with acetaminophen addresses the patient's discomfort without the need for aggressive interventions. Other choices, like administering epinephrine, are not appropriate for this type of reaction, as epinephrine is primarily used for anaphylactic or severe allergic reactions. Resuming transfusion after symptoms resolve is contraindicated in cases of febrile nonhemolytic transfusion reactions due to the risk of recurrent symptoms. Also, while blood cultures may be necessary in cases of suspected bacterial contamination or hemolytic transfusion reactions, they are not indicated specifically for managing