From the Research
For pediatric blood transfusion reactions, pheniramine (an antihistamine) is typically dosed at 0.5-1 mg/kg/dose intravenously, with a maximum single dose of 25-50 mg, as supported by the most recent and highest quality study available 1. This medication should be administered slowly over 5-10 minutes when treating acute transfusion reactions. For prophylaxis before blood transfusions in children with previous reactions, the same dose can be given 30 minutes prior to transfusion. Pheniramine works by blocking histamine H1 receptors, helping to reduce symptoms of mild to moderate allergic transfusion reactions such as urticaria, pruritus, and flushing. It's essential to note that pheniramine is just one component of transfusion reaction management, which should also include:
- Stopping the transfusion immediately
- Maintaining IV access
- Monitoring vital signs
- Potentially administering other medications based on reaction severity Dosing may need adjustment for patients with renal or hepatic impairment. Always have emergency medications and equipment available when administering blood products to children, as severe reactions may require additional interventions, as highlighted in 2 and 3. The incidence of transfusion reactions in pediatric patients is higher compared to adults, with a rate of 6.2 reactions per 1000 transfusions, as reported in 3. Therefore, it is crucial to be vigilant and prepared to manage transfusion reactions in pediatric patients, prioritizing their morbidity, mortality, and quality of life outcomes.