Effect of premedication guidelines and leukoreduction on the rate of febrile nonhaemolytic platelet transfusion reactions

Abstract

Platelet transfusion reactions were prospectively studied in haematology/oncology patients at five university teaching hospitals over three consecutive summers. The initial summer study provided baseline information on the use of premedications and the rate of platelet transfusion reactions (fever, chills, rigors and hives). Most (73%) platelet recipients were premedicated and 30% (95% CI 28-33%) of transfusions were complicated by reactions. The second study followed implementation of guidelines for premedicating platelet transfusions. Despite a marked reduction in premedication (50%), there was little change in the platelet transfusion reaction rate, 26% (95% CI 24-29%), or the type of reactions. The third study followed implementation of prestorage platelet leukoreduction while maintaining the premedication guidelines. The reaction rate decreased to 19% (95% CI 17-22%). For nonleukoreduced platelets, there was a statistically significant association between the platelet age and reaction rate (P = 0.04). For leukoreduced platelets, there was no statistically significant association between platelet age and reaction rate (P = 0.5). Plasma reduction of nonleukoreduced platelet products also reduced the reaction rate. These prospective studies document a high rate of platelet transfusion reactions in haematology/oncology patients and indicate premedication use can be reduced without increasing the reaction rate. Prestorage leukoreduction and/or plasma reduction of platelet products reduces but does not eliminate febrile nonhemolytic platelet transfusion reactions.

Red cell transfusion and the immune system

“…Soluble factors in the supernatant may be pyrogenic, including cytokines released during storage, particularly at room temperature [49,50]. Lin et al [51] demonstrated higher levels of IL-6 and -8 in post-red cell patients, including baseline IL-6 levels in cases vs controls, although cytokine levels did not vary accordingly in transfused products.…”

CMV and transfusions, an old story that's not quite over yet

“…Many other actual or potential benefits of LR have been described. These include: reduced febrile nonhemolytic transfusion reactions; 92,93 alloimmunization to HLA and other antigens, …”

Daucosterol derived from Cordyceps (a Traditional Chinese Medicine) as a possible lead compound for allergic transfusion reactions

“…Allergic transfusion reaction is one of the two most common forms of transfusion reaction, the other being febrile non-hemolytic transfusion reactions (Ezidiegwu et al, 2004;Patterson et al, 2000). Allergic transfusion reaction is classified as mild or severe based on the symptoms that develop within several hours of transfusion, mild allergic reactions cause erythematous circumscribed lesions, with or without pruritus while severe allergic reactions (anaphylaxis) causes systemic symptoms of dyspnoea, wheezing, hypotension, tachycardia, loss of consciousness, shock, and in rare cases death (Tobian et al, 2007).…”

“…For their prevention anti-inflammatory drugs with pre-transfusion medication are used, with its efficacy and safety in question (Martí-Carvajal et al, 2010). Three kinds of drugs are commonly used for this pre-transfusion medication, either alone or in combination (Patterson et al, 2000). United States Physicians use acetaminophen and diphenhydramine as effective therapies for fever and allergy, respectively (Geiger and Howard, 2007).…”

“…However, these medications are not standardized and there is controversy about their effectiveness (Patterson et al, 2000). So in this study we are using computeraided drug designing platform to find new leads against allergic transfusion reaction.…”