From the Guidelines
Premedication Prior to Blood Transfusion
Premedication prior to blood transfusion is rarely required for patients without a history of long-term transfusion, but when needed, it typically consists of acetaminophen or antihistamine 1.
- The primary goal of premedication is to minimize adverse transfusion reactions, such as fever and allergic responses.
- For most patients, acetaminophen and diphenhydramine are commonly used premedications, administered 30 minutes to 1 hour before the transfusion 1.
- The specific premedication regimen may vary depending on the individual patient's medical history and the type of blood product being transfused.
- In cases where repeated transfusions are required, leukocyte-reducing blood and the use of premedication can help minimize adverse transfusion reactions 1.
- It is essential to note that the use of premedication should be tailored to the individual patient's needs, taking into account their medical history and the specific transfusion requirements.
From the Research
Premedication Use Prior to Blood Transfusion
The use of premedication prior to blood transfusion is a common practice, although its effectiveness has not been consistently demonstrated.
- Premedication with acetaminophen or diphenhydramine is often used to prevent febrile non-haemolytic or allergic reactions, which occur in 0.1-30% of transfusions 2.
- However, studies have shown that premedication with acetaminophen or diphenhydramine may not be effective in preventing these reactions, with some studies suggesting a potential increase in the odds of febrile or allergic reactions 2, 3.
- A systematic literature review found moderate quality evidence to support the use of leukoreduction in minimizing febrile nonhemolytic transfusion reactions, but not allergic transfusion reactions, and did not find evidence to support the use of premedications in minimizing transfusion-related reactions 3.
- Other studies have also found that premedication use is infrequent and may not be necessary, with one study finding that only 1.6% of transfusions were associated with premedication medications to prevent an acute transfusion reaction 4.
- A meta-analysis of anti-allergic agents, including dexamethasone, chlorpheniramine, and promethazine, found no significant differences in transfusion reaction rates between treatment and control groups, suggesting that these agents may not be effective in preventing transfusion reactions 5.
- A national survey in Japan found that premedication is commonly used, with antihistamines and hydrocortisone being the most frequently used drugs, despite a lack of evidence supporting their use 6.
Types of Premedication Used
- Acetaminophen and diphenhydramine are commonly used as premedications to prevent febrile non-haemolytic or allergic reactions 2, 3.
- Anti-allergic agents, such as dexamethasone, chlorpheniramine, and promethazine, are also used, although their effectiveness has not been consistently demonstrated 5.
- Antihistamines and hydrocortisone are commonly used in Japan, despite a lack of evidence supporting their use 6.
Frequency of Premedication Use
- Premedication use is infrequent, with one study finding that only 1.6% of transfusions were associated with premedication medications to prevent an acute transfusion reaction 4.
- A national survey in Japan found that more than half of experts recognized premedication as efficient and necessary, although institutional guidelines were not established 6.