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The norm for febrile reactions is 1C or 2F based on the pre-transfusion vital signs. Please keep in mind that some of the suggestions provided need to be evaluated by your medical director as he/she will determine what other tests (if any) need to be added to the work-up. Having said that, we do not culture every single transfusion reaction. I have worked at different blood banks throughout the years and this is what I have found. Some facilities based the use of an automatic blood culture on temperature increments from pre-transfusion vital signs of 1 C or 2F. Other implemented the same parameter but added chills to the mix, so if the patient presented with at least these two symptoms a culture was done. Other sites included the temperature ranges listed plus a drop in blood pressure of 30mmHg whether systolic or diastolic. If the temperature difference was 0.5C or 1F a culture was not generated. I have not seen any requirements based on pulse, however, pulse can be evaluated alongside other symptoms to determine a bigger or more complex reaction. I would not culture every single transfusion reaction regardless of blood component. I would, however, sit down with your medical director and nursing to establish different protocols as to when to order a transfusion reaction and what tests need to be run to fulfill regulatory suggestions and requirements. Transfusion reactions tend to be under-reported so transparency and transfusion administration education from healthcare providers is key to address these issues. I might have not provided specific answers but this is one of those processes that require your site to feel comfortable with work-ups and tests ordered. Patient safety and stewardship of resources is key to any process. I hope this helps. Thanks Frank