title: The prevention of adverse reactions to transfusions in patients with haemoglobinopathies: a proposed algorithm.
abstract: BACKGROUND
  Transfusion therapy remains the main treatment for patients with severe haemoglobinopathies, but can cause adverse reactions which may be classified as immediate or delayed. The use of targeted prevention with drugs and treatments of blood components in selected patients can contribute to reducing the development of some reactions.The aim of our study was to develop an algorithm capable of guiding behaviours to adopt in order to reduce the incidence of immediate transfusion reactions.
  
  
  METHODS
  Immediate transfusion reactions occurring over a 7-year period in 81 patients with transfusion-dependent haemoglobinopathies were recorded. The patients received transfusions with red cell concentrates that had been filtered prestorage. Various measures were undertaken to prevent transfusion reactions: leucoreduction, washing the red blood cells, prophylactic administration of an antihistamine (loratidine 10 mg tablet) or an antipyretic (paracetamol 500 mg tablet).
  
  
  RESULTS
  Over the study period 20,668 red cell concentrates were transfused and 64 adverse transfusion reactions were recorded in 36 patients. The mean incidence of reactions in the 7 years of observation was 3.1‰. Over the years the incidence gradually decreased from 6.8‰ in 2004 to 0.9‰ in 2010.
  
  
  CONCLUSIONS
  Preventive measures are not required for patients who have an occasional reaction, because the probability that such a type of reaction recurs is very low. In contrast, the targeted use of drugs such as loratidine or paracetamol, sometimes combined with washing and/or double filtration of red blood cells, can reduce the rate of recurrent (allergic) reactions to about 0.9‰. The system for detecting adverse reactions and training staff involved in transfusion therapy are critical points for reliable collection of data and standardisation of the detection system is recommended for those wanting to monitor the incidence of all adverse reactions, including minor ones.
authors.affiliation: Service of Immunohaematology and Transfusion Medicine, Ragusa, Italy. fbennardello@asp.rg.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Bennardello
authors.forename: Carmelo
authors.initials: C
authors.lastname: Fidone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Spadola
authors.forename: Sergio
authors.initials: S
authors.lastname: Cabibbo
authors.forename: Simone
authors.initials: S
authors.lastname: Travali
authors.forename: Giovanni
authors.initials: G
authors.lastname: Garozzo
authors.forename: Agostino
authors.initials: A
authors.lastname: Antolino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tavolino
authors.forename: Cadigia
authors.initials: C
authors.lastname: Falla
authors.forename: Pietro
authors.initials: P
authors.lastname: Bonomo
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000465:Algorithms; D058633:Antipyretics / Q000008:administration & dosage*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006453:Hemoglobinopathies / Q000628:therapy*; D006633:Histamine Antagonists / Q000008:administration & dosage*; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D047589:Leukocyte Reduction Procedures; D008297:Male; D012189:Retrospective Studies
chemical_list: D058633:Antipyretics; D006633:Histamine Antagonists; D000082:Acetaminophen