Acetaminophen and diphenhydramine as premedication for platelet transfusions: A prospective randomized double‐blind placebo‐controlled trial

Wang, Stephen E; Lara, Primo N.; Lee-Ow, Angie; Reed, Jeanne; Wang, Lori R.; Palmer, P. E. S.; Tuscano, Joseph M.; Richman, Carol M.; Beckett, Laurel A.; Wun, Ted

doi:10.1002/ajh.10119

Cited by 85 publications

(123 citation statements)

References 20 publications

(40 reference statements)

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“…Only very few studies have been made to study the usefulness of premedication; mostly acetaminophen was used as an antipyretic drug and diphenhydramin for the prevention of allergic reactions (see below). The small prospective and randomized trial by Wang et al [14] revealed no difference in incidence of FNHTRs between the group of patients treated with acetaminophen and the control group. Also the retrospective analysis of the pediatric patients yielded no favorable effect [15].…”

Section: Febrile Non-hemolytic Transfusion Reactionsmentioning

confidence: 92%

Reactions Induced by Platelet Transfusions

Kiefel¹

2008

Transfus Med Hemother

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Platelet transfusions play a central role in therapeutic regimens for patients with hematologic/oncologic diseases who develop severe thrombocytopenia either in the course of their disease or following cytostatic therapy. Like other blood components, platelet transfusions have achieved a high degree of safety as far as transmission of viral diseases is concerned. However, transfusion of platelet concentrates is accompanied by a high frequency of febrile and anaphylactoid reactions. In rare cases, recipients of platelet concentrates are threatened by severe reactions as septic complications due to bacterial contamination of platelet concentrates, transfusionrelated acute lung injury and severe anaphylactic episodes.

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Section: Febrile Non-hemolytic Transfusion Reactionsmentioning

confidence: 92%

Reactions Induced by Platelet Transfusions

Kiefel¹

2008

Transfus Med Hemother

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“…1,3,43,44 In a study of 7,900 transfusions administered in a pediatric cancer center, no premedication was administered before 2,521 (32%) transfusions; acetaminophen alone was used as premedication in 1,064 (13%), diphenhydramine alone in 1,271 (16%), and both drugs in 3,044(38%). The strongest predictor of who would receive premedication was whether the patient had been premedicated for a previous transfusion.…”

Section: Premedication With Acetaminophen and Diphenhydramine Prevalementioning

confidence: 99%

“…The only randomized, double-blind, placebo-controlled clinical trial of premedication use showed no difference in the rate of FNHTR with or without premedication. 44 The trial included 98 transfusions in 51 adult oncology patients. The rate of reactions was 15.2% in patients premedicated with placebo versus 15.4% in those premedicated with 650 mg acetaminophen orally and 25 mg diphenhydramine intravenously (P =0.94).…”

Section: Clinical Studies Of the Utility Of Premedication In The Prevmentioning

confidence: 99%

Acetaminophen and Diphenhydramine Premedication for Allergic and Febrile Nonhemolytic Transfusion Reactions: Good Prophylaxis or Bad Practice?

Geiger¹,

Howard²

2007

Transfusion Medicine Reviews

113

111

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Febrile non-hemolytic and allergic reactions are the most common transfusion reactions, but usually do not cause significant morbidity. In an attempt to prevent these reactions, US physicians prescribe acetaminophen or diphenhydramine premedication before more than 50% of blood component transfusions. Acetaminophen and diphenhydramine are effective therapies for fever and allergy respectively, so their use in transfusion has some biologic rationale. However, these medications also have potential toxicity, particularly in ill patients, and in the studies performed to date, they have failed to prevent transfusion reactions. Whether the benefits of routine prophylaxis with acetaminophen and diphenhydramine outweigh their risks and cost requires re-examination, particularly in light of the low reaction rates reported at many institutions even when pre-medication is not prescribed.The most common acute adverse reactions to blood-component transfusions, febrile nonhemolytic transfusion reactions (FNHTRs) and allergic reactions, are fortunately among the least harmful. Blood recipients with FNHTRs experience fever (often defined as a temperature rise ≥ 1°C above baseline) and/or rigors within 3 hours of transfusion. Allergic reactions are most often associated with the development of urticaria or other rash, pruritus, wheezing, or angioedema within several hours of transfusion. 1-8 These reactions are temporally limited, self-resolving, and generally pose little risk of causing lasting harm. Mild reactions often consist of a limited increase of temperature without other symptoms or a localized urticarial exanthem. In moderate and severe reactions, rigors and fever may be severe with rapid onset and associated with other symptoms, and urticaria may be extensive and painful or include respiratory or other systemic symptoms.How an incipient urticarial or FNHTR will progress cannot be predicted on the basis of its initial presentation. Further, it is often not possible to distinguish the symptoms of mild reactions from early symptoms of other more consequential problems such as sepsis, hemolytic reactions, or anaphylaxis. Therefore, the earliest indication of a reaction mandates discontinuation of a transfusion and, except for the mildest urticarial reactions, its termination. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errorsmaybe discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Increased clinical and laboratory monitoring is necessary, and infusion of replacement blood may be required. Blood replacement is associated with additional transfusion-associated risks and may deplete low blood inventories. The development of repeated rea...

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“…Nonetheless they cause considerable distress to patients and families and sometimes lead to significant diagnostic or therapeutic interventions, particularly in neutropenic patients. It is not clear whether strategies for prevention, such as medication with an antipyretic or antihistamine, are safe and effective 10,11 . Furthermore, most low toxicity anti‐inflammatory drugs are relatively contraindicated in thrombocytopenic patients due to concerns about their effects on PLT function.…”

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confidence: 99%