Acetaminophen and Diphenhydramine Premedication for Allergic and Febrile Nonhemolytic Transfusion Reactions

Good Prophylaxis or Bad Practice?

Terrence L. Geiger, Scott Howard

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Febrile nonhemolytic and allergic reactions are the most common transfusion reactions, but usually do not cause significant morbidity. In an attempt to prevent these reactions, US physicians prescribe acetaminophen or diphenhydramine premedication before more than 50% of blood component transfusions. Acetaminophen and diphenhydramine are effective therapies for fever and allergy, respectively, so their use in transfusion has some biologic rationale. However, these medications also have potential toxicity, particularly in ill patients, and in the studies performed to date, they have failed to prevent transfusion reactions. Whether the benefits of routine prophylaxis with acetaminophen and diphenhydramine outweigh their risks and cost requires reexamination, particularly in light of the low reaction rates reported at many institutions even when premedication is not prescribed.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalTransfusion Medicine Reviews
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2007

Fingerprint

Diphenhydramine
Premedication
Acetaminophen
Fever
Hypersensitivity
Blood Component Transfusion
Allergies
Induced Hyperthermia
Reaction rates
Toxicity
Blood
Morbidity
Physicians
Costs and Cost Analysis
Transfusion Reaction
Costs

All Science Journal Classification (ASJC) codes

  • Hematology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

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abstract = "Febrile nonhemolytic and allergic reactions are the most common transfusion reactions, but usually do not cause significant morbidity. In an attempt to prevent these reactions, US physicians prescribe acetaminophen or diphenhydramine premedication before more than 50{\%} of blood component transfusions. Acetaminophen and diphenhydramine are effective therapies for fever and allergy, respectively, so their use in transfusion has some biologic rationale. However, these medications also have potential toxicity, particularly in ill patients, and in the studies performed to date, they have failed to prevent transfusion reactions. Whether the benefits of routine prophylaxis with acetaminophen and diphenhydramine outweigh their risks and cost requires reexamination, particularly in light of the low reaction rates reported at many institutions even when premedication is not prescribed.",
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