Acetaminophen and diphenhydramine premedication for allergic and febrile nonhemolytic transfusion reactions: good prophylaxis or bad practice?
Febrile nonhemolytic 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 reexamination, particularly in light of the low reaction rates reported at many institutions even when premedication is not prescribed.
Geiger
Terrence L
TL
Department of Pathology and Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA. terrence.geiger@stjude.org
Howard
Scott C
SC
D000082:Acetaminophen / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D018926:Anti-Allergic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016913:Blood Component Transfusion / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D004155:Diphenhydramine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005334:Fever / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D006967:Hypersensitivity / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*
D018712:Analgesics, Non-Narcotic; D018926:Anti-Allergic Agents; D000082:Acetaminophen; D004155:Diphenhydramine