Case 62 -- Fever and Severe Rigors During Transfusion


The patient was diagnosed with breast cancer in 1992. She subsequently underwent left radical mastectomy. A CT scan revealed evidence of metastasis in November of 1995. In January 1996 she received VP-16 and Cytoxan chemotherapy followed by stem cell mobilization. She presented on January 28, 1996 with recurrent fevers and neutropenia. Vancomycin and Imipenem were started. Cultures obtained from the patient remained negative.

The patient defervesced and continued to receive red cell and platelet support. One week into the hospital course she began infusion of a filtered, irradiated 6 unit pool of platelets. Twenty-four hours prior to transfusion the patient was afebrile at 37 degrees Celsius. Transfusion began at 5:00pm and at 5:25 the patient developed severe rigors. The transfusion was stopped and at 5:40 the temperature rose to 39 degrees Celsius. No hypotension was reported. The patient was already receiving intravenous antibiotics. Tylenol and meperidine were then administered as treatment.

The platelet bag was sent back to the blood bank for transfusion work-up including culture. Patient blood cultures were also drawn.




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