Febrile nonhemolytic transfusion reactions. Management by premedication and cost implications in adult patients.
BACKGROUND
Febrile nonhemolytic transfusion reactions (FNHTRs) cause unwelcome interruptions during the course of blood product transfusions and necessitate measures to verify the nature of the reaction and to exclude certain dangerous reactions, such as hemolytic and septic phenomena.


OBJECTIVE
To examine transfusion medicine data to determine the clinical implications of the routine administration of antipyretic medication to adult patients before transfusion for the prevention of FNHTRs.


METHODS
A retrospective review was conducted of FNHTR data during 5 years (1998-2002), and a determination was made of the cost of a transfusion complicated by an FNHTR. In addition, a comparative cost analysis was performed using our data and published data on the incidence of FNHTRs. The clinical implications of medication with respect to possible drug-induced adverse effects were assessed, as well as the potential interference with diagnosing other forms of transfusion reactions and the mitigation of the clinical effect of an FNHTR.


RESULTS
For nearly 120,000 U of transfused blood components, approximately 80% of which were preceded by antipyretic medication during the study period, the overall incidence of FNHTR was found to be 0.09%. Furthermore, there was no evidence of antipyretic-associated complications, nor any evidence that antipyretics prevented the recognition of other more dangerous complications of transfusions.


CONCLUSIONS
Our findings indicate that this practice provides significant advantages to the recipient of a transfusion, but does not appear to yield significant cost benefits for the health care provider.
Ezidiegwu
Christian N
CN
Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY 13210, USA.
Lauenstein
Karla J
KJ
Rosales
Lazaro G
LG
Kelly
Karen C
KC
Henry
John Bernard
JB
D000082:Acetaminophen / Q000191:economics; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000191:economics* / Q000627:therapeutic use; D001803:Blood Transfusion / Q000191:economics*; D003365:Costs and Cost Analysis; D005334:Fever / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D011292:Premedication / Q000191:economics*; D012189:Retrospective Studies; D065227:Transfusion Reaction
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen