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Premedication with acetaminophen or diphenhydramine for transfusion with leucoreduced blood products in children
Robert P Sanders1, Sunil D Maddirala, Terrence L Geiger
1Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN, USA. robert.sanders@carolinashealthcare.org
Insights
Premedication with acetaminophen or diphenhydramine did not significantly reduce febrile or allergic transfusion reactions. These reactions were rare in pediatric patients receiving specific blood products, regardless of premedication.
Area of Science:
- Transfusion Medicine
- Hematology
- Clinical Pharmacology
Background:
- Febrile non-hemolytic and allergic reactions are common transfusion complications.
- Physicians frequently use acetaminophen and diphenhydramine for premedication to prevent these reactions.
- The efficacy of routine premedication for transfusion reactions is not well-established.
Purpose of the Study:
- To evaluate the effectiveness of acetaminophen and diphenhydramine premedication in preventing febrile and allergic transfusion reactions.
- To analyze the incidence of transfusion reactions in patients receiving leucoreduced, irradiated blood products.
Main Methods:
- Retrospective review of 7900 transfusions (apheresis platelets and packed red blood cells) in 385 patients during 2002.
- Analysis of febrile reactions with acetaminophen premedication and allergic reactions with diphenhydramine premedication.
- Multivariate analysis adjusting for patient and transfusion characteristics.
Main Results:
- Acetaminophen premedication showed a non-significant increase in febrile reactions (OR 1.74, P=0.22).
- Diphenhydramine premedication showed a non-significant increase in allergic reactions (OR 1.74, P=0.054).
- Transfusion reactions were rare in pediatric patients receiving leucoreduced, irradiated products, irrespective of premedication.
Conclusions:
- Routine premedication with acetaminophen or diphenhydramine may not be effective in preventing febrile or allergic transfusion reactions.
- Leucoreduced, irradiated blood products are associated with a low incidence of reactions, particularly in pediatric populations.
- Further investigation into optimal strategies for transfusion reaction prevention is warranted.
Abstract:
Febrile non-haemolytic or allergic reactions occur in 0.1-30% of transfusions; physicians often premedicate patients with acetaminophen or diphenhydramine to prevent these reactions. The effectiveness of this practice has not been demonstrated. In this retrospective review of all transfusions at our institution during 2002, 385 patients received 7900 evaluable leucoreduced, irradiated blood products (4280 single-donor apheresis platelets and 3620 packed red blood cells). Febrile reactions occurred in 0.95% of 4108 transfusions with, and 0.53% of 3792 transfusions without, acetaminophen premedication. Allergic reactions occurred in 0.90% of 4315 transfusions with, and 0.56% of 3585 transfusions without, diphenhydramine premedication. In a multivariate analysis that adjusted for age, patient category, transfusion location, product, transfusion history, and reaction history, premedication with acetaminophen was associated with a statistically non-significant increase in the odds of a febrile reaction (odds ratio 1.74; 95% confidence interval 0.71-4.23; P = 0.22), and diphenhydramine with a non-significant increase in allergic reactions (odds ratio 1.74; 95% confidence interval 0.99-3.06; P = 0.054). Reactions occurred in only 1.3% of the 518 transfusions to patients with a history of two or more prior reactions. Febrile and allergic transfusion reactions were rare in paediatric patients transfused with leucoreduced, irradiated blood products, whether premedication was used or not.
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