From the Research
For pediatric blood transfusion reactions, pheniramine (an antihistamine) is typically dosed at 0.5-1 mg/kg/dose given intravenously, with a maximum single dose of 25-50 mg, as supported by the most recent evidence 1. This medication should be administered slowly over 10-15 minutes to prevent hypotension. For mild transfusion reactions, pheniramine can be given along with stopping the transfusion temporarily and administering acetaminophen if fever is present. The dose may be repeated every 6 hours as needed based on symptoms. When administering pheniramine, monitor the child for sedation, dry mouth, and hypotension as common side effects. Pheniramine works by blocking histamine H1 receptors, thereby reducing the allergic response that occurs during transfusion reactions. It's essential to note that while antihistamines like pheniramine help manage symptoms of mild to moderate transfusion reactions, severe reactions may require additional interventions including epinephrine, corticosteroids, and supportive care. Always adjust the dose based on the child's weight and clinical response, and ensure emergency medications and equipment are available when administering blood products to pediatric patients.
Some key points to consider when managing pediatric blood transfusion reactions include:
- The incidence of adverse outcomes is higher in pediatric patients compared to adults, with an estimated incidence of 18:100,000 red blood cells issued for children aged less than 18 years and 37:100,000 for infants 2.
- Pediatric patients have a higher reaction rate compared to adults, with statistically higher rates of allergic reactions, febrile nonhemolytic reactions, and acute hemolytic reactions 1.
- The majority of transfusion reactions in pediatric patients are allergic in nature, and antihistamines like pheniramine are effective in managing these reactions 3.
- It is crucial to have emergency medications and equipment available when administering blood products to pediatric patients, as severe reactions can occur 4, 5.