1.
Premedication for the prevention of nonhemolytic transfusion reactions: a systematic review and meta-analysis
Ning S, Solh Z, Arnold DM, Morin PA
Transfusion. 2019
Abstract
BACKGROUND The efficacy of premedication for the prevention of nonhemolytic transfusion reactions remains controversial. This systematic review and meta-analysis assessed the effect of premedication on the rate of nonhemolytic transfusion reactions after allogeneic blood transfusion. STUDY DESIGN AND METHODS We searched the literature using CENTRAL, MEDLINE, EMBASE, ISI Web of Science, and clinicaltrials.gov databases from inception until October 31, 2018. We included all randomized controlled trials comparing premedication to placebo or no treatment in patients receiving any labile blood product. Outcome measures were reported as relative risks (RRs) with 95% confidence intervals (CIs). Data were combined for similar outcomes where appropriate using a random-effects model. Analyses were done at both the patient and transfusion level. RESULTS Three randomized trials using acetaminophen and antihistamine as premedication met the inclusion criteria. A total of 517 patients received 4444 red blood cell or platelet transfusions. Pooled patient-level estimates with premedication for all nonhemolytic, febrile nonhemolytic, and minor allergic reactions were RR, 0.92 (95% CI, 0.63-1.35); RR, 0.54 (95% CI, 0.26-1.1); and RR, 1.37 (95% CI 0.81-2.31), respectively. Transfusion-level analyses also showed no benefit with premedication. Of 517 patients randomized, only 27 (5.2%) had a history of transfusion reactions. CONCLUSION Routine premedication with acetaminophen and antihistamines did not prevent nonhemolytic transfusion reactions; however, the estimate of effect was greatest for febrile reactions. The impact of premedication in patients with a prior history of transfusion reactions remains unknown and requires further evaluation in future clinical trials.
2.
Effects of leukoreduction and premedication with acetaminophen and diphenhydramine in minimizing febrile nonhemolytic transfusion reactions and allergic transfusion reactions during and after blood product administration: a literature review with recommendations for practice
Duran J, Siddique S, Cleary M
Journal of Pediatric Oncology Nursing. 2014;31((4):):223-229.
Abstract
Transfusion-related reactions cause unwanted interruptions in blood-product administration and potential complications for patients. The most common reactions are febrile nonhemolytic transfusion reactions (FNHTRs) and allergic transfusion reactions (ATRs). The presence of leukocytes in blood products has been associated with these reactions, and efficacy of leukoreduction in minimizing FNHTRs and ATRs has recently been investigated. In addition, premedication with acetaminophen and diphenhydramine is the most widely used practice in minimizing FNHTRs and ATRs, yet the benefit of this is not supported by research. The aim of this systematic literature review was to evaluate the potential benefits of both of these interventions in minimizing FNHTRs and ATRs and provide recommendations for practice. We found moderate quality evidence with strong recommendations for the practice of leukoreduction in minimizing FNHTRs but not ATRs. We did not find evidence to support the use of premedications in minimizing transfusion-related reactions, and we question the need for this practice in settings where leukoreduction is used. Copyright © 2014 by Association of Pediatric Hematology/Oncology Nurses.
3.
Randomized clinical controlled cross-over trial (RCT) in the prevention of blood transfusion febrile reactions with small dose hydrocortisone versus anti-histamines Chinese
Wang JS, Sackett DJ, Yuan YM
Chung-Hua Nei Ko Tsa Chih [Chinese Journal of Internal Medicine]. 1992;31((9):):536-8.
Abstract
RCT was used in 73 patients who had experienced blood transfusion febrile reactions. For further two transfusions Benadryl was used before the first transfusion and hydrocortisone before the second in 36 patients. In the other group of 37 patients hydrocortisone was administered before the first the and Benadryl before the second transfusion. The effective rate of preventing transfusion febrile reactions with Benadryl (72.6%) was not significantly different from that with hydrocortisone (86.3%).