From the Guidelines
Premedication before blood transfusion is not routinely recommended, but for patients with a history of transfusion reactions, acetaminophen or diphenhydramine may be considered. When considering premedications, it's essential to prioritize the patient's history and type of previous reaction. According to the most recent guidelines, premedication with acetaminophen or diphenhydramine may be beneficial for patients with a history of mild to moderate transfusion reactions 1.
Key Considerations
- The decision to premedicate should be individualized based on the patient's history and type of previous reaction.
- Premedication does not prevent serious reactions like acute hemolytic transfusion reactions or transfusion-related acute lung injury.
- Patients receiving their first transfusion or those with no history of reactions do not benefit from premedication and may have masked early signs of a reaction.
Recommended Premedications
- Acetaminophen (650 mg orally) 30 minutes prior to transfusion for patients with recurrent febrile non-hemolytic transfusion reactions.
- Diphenhydramine (25-50 mg orally or intravenously) 30 minutes before transfusion for patients with a history of mild to moderate transfusion reactions.
Monitoring
- Close monitoring of patients during transfusion is crucial, regardless of premedication status, watching for signs of reaction such as fever, chills, urticaria, respiratory distress, or hypotension.
From the FDA Drug Label
Directions • take every 4 to 6 hours, or as directed by a physician• do not take more than 6 doses in 24 hours agedose Adults and children over 12 years of age10 mL (25 mg) to 20 mL (50 mg) Children 6 to under 12 years of age10 mL (25 mg) Children under 6 years of ageDo not use The FDA drug label does not answer the question.
From the Research
Premedications before Blood Transfusion
- The use of premedications such as acetaminophen and diphenhydramine before blood transfusion has been studied in several trials 2, 3, 4, 5, 6.
- A prospective, randomized, double-blind controlled trial found that pretransfusion medication with acetaminophen and diphenhydramine did not decrease the overall risk of transfusion reactions, but may decrease the risk of febrile nonhemolytic transfusion reactions to leukoreduced blood products 2.
- A literature review found moderate quality evidence to support the use of leukoreduction in minimizing febrile nonhemolytic transfusion reactions, but did not find evidence to support the use of premedications in minimizing transfusion-related reactions 3.
- A retrospective review of transfusions in children found that premedication with acetaminophen or diphenhydramine was not associated with a significant decrease in the risk of febrile or allergic reactions 4.
- A review of the use of acetaminophen and diphenhydramine as premedication for allergic and febrile nonhemolytic transfusion reactions found that these medications have potential toxicity and have failed to prevent transfusion reactions in studies performed to date 5.
- A prospective randomized double-blind placebo-controlled trial found that premedication with acetaminophen and diphenhydramine did not significantly lower the incidence of non-hemolytic transfusion reactions as compared to placebo 6.
Types of Premedications
- Acetaminophen and diphenhydramine are the most commonly used premedications for blood transfusion 2, 3, 4, 5, 6.
- The use of these medications as premedication has been questioned due to their potential toxicity and lack of evidence to support their effectiveness in preventing transfusion reactions 3, 5.
Patient Populations
- The use of premedications before blood transfusion has been studied in various patient populations, including hematology/oncology patients 2, pediatric patients 4, and patients receiving platelet transfusions 6.
- The evidence suggests that premedications may not be necessary for all patient populations, and that the decision to use premedications should be made on a case-by-case basis 3, 5.