From the Guidelines
For patients with a previous transfusion reaction to platelets, a personalized premedication approach is recommended, tailored to the patient's symptoms and signs, rather than indiscriminate use of steroids and/or antihistamines. According to the most recent guidelines from the Association of Anaesthetists 1, current recommendations advise against the use of steroids and/or antihistamines indiscriminately. Instead, for febrile reactions, only intravenous paracetamol may be required, while for allergic reactions, only an antihistamine should be administered.
Key Considerations
- The type and severity of previous reactions should be documented to tailor the premedication approach appropriately 1.
- For patients with severe previous reactions, a more aggressive premedication regimen may be necessary, but this should be guided by the patient's specific symptoms and signs.
- The use of leukoreduced blood products, washed platelets, or HLA-matched platelets may be beneficial in certain cases, but the decision to use these products should be made on a case-by-case basis, taking into account the patient's individual needs and reaction history.
Premedication Protocol
- Intravenous paracetamol may be used for febrile reactions, as it can help reduce fever and inflammation 1.
- An antihistamine, such as diphenhydramine, may be used for allergic reactions, as it can help block histamine receptors and alleviate symptoms.
- Corticosteroids, such as methylprednisolone, may be used in certain cases, but their use should be guided by the patient's specific symptoms and signs, and they should not be used indiscriminately due to the potential for immune suppression 1.
From the Research
Premedication Protocol for Patients with Previous Transfusion Reaction to Platelets
The recommended premedication protocol for patients with a previous transfusion reaction to platelets is not well established. However, several studies have investigated the use of acetaminophen and diphenhydramine as premedication for platelet transfusions.
- A prospective randomized double-blind placebo-controlled trial published in 2002 found that premedication with acetaminophen and diphenhydramine did not significantly lower the incidence of non-hemolytic transfusion reactions (NHTR) as compared to placebo 2.
- A systematic literature review published in 2014 found moderate quality evidence to support the use of leukoreduction in minimizing febrile nonhemolytic transfusion reactions (FNHTRs), but not allergic transfusion reactions (ATRs) 3.
- A retrospective review published in 2005 found that premedication with acetaminophen or diphenhydramine was not effective in preventing febrile or allergic reactions in patients receiving leucoreduced blood products 4.
- A review article published in 2007 questioned the need for routine prophylaxis with acetaminophen and diphenhydramine, citing the low reaction rates reported at many institutions even when premedication is not prescribed 5.
- A systematic review published in 2022 found that aspirin, acetaminophen, and nonselective NSAIDs may diminish the effects of platelet-rich plasma injections and should be considered for suspension before such injections 6.
Key Findings
- Acetaminophen and diphenhydramine are not effective in preventing NHTR or FNHTR in patients receiving platelet transfusions 2, 3, 4.
- Leukoreduction is effective in minimizing FNHTRs, but not ATRs 3.
- The use of premedication with acetaminophen and diphenhydramine is not supported by evidence and may be unnecessary in settings where leukoreduction is used 3, 5.