Show Me the Evidence: Is the Routine Use of Premedication for Transfusion Really Necessary?

Topic Significance & Study Purpose/Background/Rationale 

Improvements in transfusion medicine, blood typing, and donor screening have reduced the likelihood of a reaction from administration of blood products.  In an effort to prevent transfusion reactions, our current standard is to administer acetaminophen 650mg and diphenhydramine 25mg, 30 minutes before transfusions.  This practice may unnecessarily place patients at increased risk for complications including falls, cognitive impairment, and hepatic toxicity.   

Methods, Intervention, & Analysis 

P=Adult BMT/oncology patient; I=Does the prophylactic use of acetaminophen and diphenhydramine; C=versus no premedication; O=affect the incidence of blood transfusion reactions?

The evidence based practice committee (EBPC) at a comprehensive cancer center in the Midwest conducted a literature review to determine if evidence supported the efficacy for reducing transfusion reactions with routine premedication utilizing acetaminophen and diphenhydramine.  The search strategy included electronic searches of numerous resources including PubMed (MEDLINE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Medline, Elton B. Stephens Company (EBSCO), Ovid, and Scopus to gather established information.

Findings & Interpretation 

The results of one prospective, randomized, double-blind, placebo-controlled and two retrospective reviews were analyzed and failed to show any benefit to premedication prior to transfusion of blood products. Based on the evidence, the EBPC sought to obtain a baseline rate of transfusion reaction at their facility.  Between January and April 2014, a retrospective review was conducted on 137 transfusion patients to determine the frequency of transfusion-related reactions. Four transfusion reactions were reported; all four patients had been premedicated prior to transfusion.  Six patients did not receive any premedication; none of which had a transfusion-related reaction.

Discussion & Implications 

The chair of the EBPC presented these findings at BMTQI. Committee concerns included the possible increase in confounding febrile reactions that might lead to unnecessary admissions and febrile transfusion reaction work-ups. A compromise was reached with the BMTQI committee approving the elimination of Benadryl as a routine premedication. Next steps will include implementation of this new protocol with additional data collection on rate of transfusion reactions for the next three months.  If results concur with reviewed evidence, this protocol change will be expanded across the facility and can be a platform for other centers who are still using premedication.