A national survey of premedication for transfusion reactions in Japan

Fujiwara, Shin-ichiro; Kino, Shuichi; Tanaka, Asashi; Hasegawa, Yoshinori; Yokohama, Akihiko; Fujino, Keizo; Makino, Shigeyoshi; Matsumoto, Mayumi; Takeshita, Akira; Muroi, Kazuo

doi:10.1016/j.transci.2017.07.024

Cited by 9 publications

(10 citation statements)

References 14 publications

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“…Acetaminophen and chlorpheniramine maleate (CPM) are commonly used as premedications to prevent transfusion reactions from prestorage leukoreduced, poststorage leukoreduced, or nonleukoreduced blood products in most of the developing countries with variable practice guidelines among different institutions even though the literatures support that idea that pretransfusion medication is required only when transfusion reactions occur [ 18 , 20 – 23 ]. The previous study [ 24 , 25 ] suggested that there is no medical benefit of administering pretransfusion medication and also questioned the cost benefits of the practice.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Oral Acetaminophen and Intravenous Chlorpheniramine Maleate versus Placebo to Prevent Red Cell Transfusion Reactions in Children and Adolescent with Thalassemia: A Prospective, Randomized, Double-Blind Controlled Trial

Rujkijyanont

Monsereenusorn

Manoonphol

et al. 2018

Anemia

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Background Thalassemia is a common congenital hemolytic disorder. In severe cases, regular blood transfusion is essentially required. The role of premedications to prevent transfusion reactions is varied among institutions with no standard guideline. Objective To prospectively compare the risk of transfusion reactions in thalassemia patients premedicated with acetaminophen and chlorpheniramine maleate (CPM) versus placebo prior to blood transfusion. Material and Method A randomized, double-blinded, placebo-controlled transfusion reaction study of 147 eligible patients was analyzed. All administered red blood cell (RBC) products were leukoreduced blood products. Patients were monitored and followed for the development of transfusion reactions for 24 hours after RBC transfusion. Results A total of 73 patients randomized to receive active drugs consisting of acetaminophen and CPM were compared to 74 patients receiving placebo. The overall incidences of febrile reaction and urticarial rash were 6.9% and 22% in the patients randomized to receive active drugs comparing with 9.5% and 35.2% in the patients receiving placebo with no significant differences between two groups. However, delayed development of urticarial rash at 4-24 hours after RBC transfusion was significantly higher in female and patients receiving placebo. Conclusion Administration of premedications in thalassemia patients receiving RBC transfusion without a history of transfusion reactions does not decrease the overall risk of transfusion reactions. However, the use of CPM might be beneficial to prevent delayed urticarial rash in those patients especially in females (Thai Clinical Trial Registry (TCTR) study ID: 20140526001).

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Section: Introductionmentioning

confidence: 99%

Efficacy of Oral Acetaminophen and Intravenous Chlorpheniramine Maleate versus Placebo to Prevent Red Cell Transfusion Reactions in Children and Adolescent with Thalassemia: A Prospective, Randomized, Double-Blind Controlled Trial

Rujkijyanont

Monsereenusorn

Manoonphol

et al. 2018

Anemia

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“…An updated systematic review to evaluate the efficacy of premedication for the prevention of NHTRs has not been performed in almost a decade. As such, the use of premedication to prevent transfusion reactions remains controversial in clinical practice …”

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confidence: 99%

Premedication for the prevention of nonhemolytic transfusion reactions: a systematic review and meta‐analysis

et al. 2019

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BACKGROUND: The efficacy of premedication for the prevention of nonhemolytic transfusion reactions remains controversial. This systematic review and meta-analysis assessed the effect of premedication on the rate of nonhemolytic transfusion reactions after allogeneic blood transfusion. STUDY DESIGN AND METHODS:We searched the literature using CENTRAL, MEDLINE, EMBASE, ISI Web of Science, and clinicaltrials.gov databases from inception until October 31, 2018. We included all randomized controlled trials comparing premedication to placebo or no treatment in patients receiving any labile blood product. Outcome measures were reported as relative risks (RRs) with 95% confidence intervals (CIs). Data were combined for similar outcomes where appropriate using a random-effects model. Analyses were done at both the patient and transfusion level. RESULTS:Three randomized trials using acetaminophen and antihistamine as premedication met the inclusion criteria. A total of 517 patients received 4444 red blood cell or platelet transfusions. Pooled patient-level estimates with premedication for all nonhemolytic, febrile nonhemolytic, and minor allergic reactions were RR, 0.92 (95% CI, 0.63-1.35); RR, 0.54 (95% CI, 0.26-1.1); and RR, 1.37 (95% CI 0.81-2.31), respectively. Transfusion-level analyses also showed no benefit with premedication. Of 517 patients randomized, only 27 (5.2%) had a history of transfusion reactions. CONCLUSION: Routine premedication withacetaminophen and antihistamines did not prevent nonhemolytic transfusion reactions; however, the estimate of effect was greatest for febrile reactions. The impact of premedication in patients with a prior history of transfusion reactions remains unknown and requires further evaluation in future clinical trials. ABBREVIATIONS: FNHTRs = febrile nonhemolytic transfusion reactions; GRADE = Grading of Recommendations Assessment, Development, and Evaluation; MARs = minor allergic reactions; NHTRs = nonhemolytic transfusion reactions; RCTs = randomized controlled trials. From the

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“…Our analysis showed that clinical care standardization is possible even when the best clinical practice is unclear. 7 , 8 For sustainability, the QI team incorporated the blood product premedication plan education into EHR training for new fellows and advanced practice providers. In addition, our interventions may be useful for other teams working on clinical care standardization, especially in situations with limiting evidence for clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Improving Blood Product Transfusion Premedication Plan Documentation: A Single-institution Quality Improvement Effort

Sitthi-Amorn

Denton

Harper

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: Premedication with acetaminophen and/or diphenhydramine to prevent febrile nonhemolytic transfusion reactions and minor allergic transfusion reactions is a common practice based on historical recommendations. However, recent small randomized-controlled trials showed no benefit of premedication. This inconsistency leads to practice variability, which results in the inefficiency of our institution’s blood product ordering process. This project aimed to improve the number of transfusion encounters with premedication plan documentation from a baseline of 19% to 80% in 12 months. Methods: A multidisciplinary quality improvement (QI) team used QI tools to design interventions to improve the efficiency of the ordering process for blood products. Measures were tracked monthly and analyzed using statistical process control. Results: From September 2018 to January 2021, 5,351 blood product transfusion visits were scheduled. At baseline, 34% of patients received premedication, and 19% had premedication plans documented. Interventions included a passive computerized provider order entry alert, clinical care pathway development, and clinician education. Postimplementation, the average number of encounters with a premedication plan increased from 19% to 87%, whereas encounters receiving premedication decreased from 34% to 25%. There was no change in the average number of transfusion reactions (1.8 per 100 transfusions). Conclusions: Using QI methods, our team successfully standardized the blood product premedication plan documentation despite unclear best practices regarding blood product transfusion premedication. The team added premedication plan documentation training to new employee orientation for sustainability.

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A national survey of premedication for transfusion reactions in Japan

Cited by 9 publications

References 14 publications

Efficacy of Oral Acetaminophen and Intravenous Chlorpheniramine Maleate versus Placebo to Prevent Red Cell Transfusion Reactions in Children and Adolescent with Thalassemia: A Prospective, Randomized, Double-Blind Controlled Trial

Efficacy of Oral Acetaminophen and Intravenous Chlorpheniramine Maleate versus Placebo to Prevent Red Cell Transfusion Reactions in Children and Adolescent with Thalassemia: A Prospective, Randomized, Double-Blind Controlled Trial

Premedication for the prevention of nonhemolytic transfusion reactions: a systematic review and meta‐analysis

Improving Blood Product Transfusion Premedication Plan Documentation: A Single-institution Quality Improvement Effort

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