Evidence-Based Minireview: The use of premedications for platelet transfusions in pediatric patients

McCormick, Meghan; Triulzi, Darrell J.

doi:10.1182/hematology.2020000165

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…The risk of FNHTRs and allergic reactions such as TRALI and TRIM are among the common TTR associated with platelet transfusion [55][56][57]. Furthermore, these TTR were linked with cytokine production from metabolically active leucocytes that remained in the bag even after pre-storage leukoreduction [10,[58][59][60].…”

Section: Discussionmentioning

confidence: 99%

Ten Days Storage of Platelets: Analysis of Quality and Safety

Grech

Baron

Zammit

2022

JAMMR

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Aims: The necessity for Platelet Concentrates (PCs) in transfusion has increased, and several measures have been undertaken to try and increase the shelf-life of this product. Increasing the shelf-life to 10 days from the current 5 days will increase availability and reduce waste and cost. However, the PCs need to maintain their safety and therapeutic efficacy over the extended storage time. To ensure the safety of this product, the bag should be sterile, with low concentrations of cytokines to prevent transfusion reactions, and the platelet indices should be within the therapeutic range to ensure efficacy. The aim of this study is to determine whether PCs retain quality standards and thus, remain fit for transfusion after being stored for 10 days in SSP+ at 22±2°C with constant agitation. Study Design: Qualitative study. Place and Duration of Study: National Blood Transfusion Service Malta, between March 2021 and June 2022. Methodology: In this study, 20 PCs were analysed by sampling on Day 5 and Day 10 of storage and tested for platelet count and indices, pH, sterility of the product and cytokine concentrations. Results: The results obtained showed a significant differences in the platelet count and platelet indices and pH. The difference in cytokine concentration of Interleukin-6 (IL-6), Tumour necrosis factor-α (TNF—α) and transforming growth factor-β (TGF-β) were not found to be statistically different between Day 5 and Day 10. Furthermore, 1 PC unit was positive during testing for bacteria detection. Conclusion: These results showed that the difference between Day 5 and Day 10 is not alarming, and further studies should be made to prolong the storage life to 10 days.

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Section: Discussionmentioning

confidence: 99%

Ten Days Storage of Platelets: Analysis of Quality and Safety

Grech

Baron

Zammit

2022

JAMMR

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“…[1][2][3][4][5] These reactions are often benign but can be time and resource-consuming, as they require evaluating the transfusion reaction and discarding blood products. 5,6 Clinicians have been using acetaminophen and diphenhydramine to prevent FNHTR and MATR for several decades. 1,2,[7][8][9] However, FNHTR and MATR have become less frequent with the increasing use of leukoreduced products.…”

Section: Introductionmentioning

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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