No Need for Premedication Before Blood Transfusion

Fran Lowry

May 01, 2015

Medicating oncology patients before they undergo a blood transfusion is not only unnecessary, it might expose them to adverse effects that can be especially harmful, new research shows.

"Premedications are not efficacious in preventing transfusion reactions," said Mary Hendrickson, RN, BSN, OCN, from the University of Colorado Hospital (UCH) in Aurora.

"A patient who is going to have a reaction to blood products will have that reaction whether or not they receive premedications," she told Medscape Medical News.

In patients who have a history of reacting to blood transfusions, however, premedication might be useful, she said.

Empirically, oncology patients receive medication before blood transfusions significantly more often than other patients, she noted at the Oncology Nursing Society 40th Annual Congress in Orlando, Florida.

"But the side effects of frequently used meds, such as and diphenhydramine and acetaminophen, can increase the risk of falls due to somnolence and can mask fever, which can be the only sign of infection for neutropenic patients," she explained.

Hendrickson began to question the practice when she was a new graduate nurse working in the Oncology and Bone Marrow Transplant (BMT) inpatient unit at UCH.

"At that time, the standard of care was to medicate all of our BMT patients prior to blood product administration. The BMT team started to discuss whether this was truly best practice, so I decided to do a research project, a requirement for new grads at UCH, on this topic," she said.

Typical adverse reactions to blood products are fever, chills, low back pain, rash, throat tightness, swelling, and anaphylaxis. It was though that if patients received medication before blood products, "they would be less likely to experience these adverse reactions," Hendrickson explained.

No Use Is Good Use

The research project involved a change in protocol, from premedication with acetaminophen 650 mg plus diphenhydramine 25 to 50 mg for all patients to premedication only for patients with a reaction history.

Hendrickson's team compared data on transfusion reactions before and after the protocol change.

In the cohort of 34,337 patients, 103 (0.003%) had a history of transfusion reaction. Of these 103 patients, 64.4% were oncology or bone marrow transplant patients.

The prevalence of adverse reactions to blood transfusion was not significantly different between the premedication and no premedication groups (P = .23). As expected, after the protocol change, patients received significantly less premedication (P = .006).

 
Even with the medication, patients still suffered adverse reactions.
 

"So even with the medication, patients still suffered adverse reactions," Hendrickson reported. "This result does not support the efficacy of premedications."

"Honestly, I would like to see further studies done to understand the benefits of premedicating patients who have had a previous transfusion reaction. I would like to see the data that support that. I'm not sure there is much out there on the specific area of premedicating for transfusion reactions," she said.

"Otherwise, I would like to see fewer premedications given to BMT patients receiving blood products throughout the country."

"The evidence from this poster identifies a change in practice," said Ruth Gholz, RN, from the Cincinnati Veterans Administration Medical Center.

"Medication to reduce the potential for blood transfusion reactions prior to receiving a blood product has been a standard of care for many years. In addition to eliminating sedation from Benadryl, the patient will not experience the restless leg side effect, thus improving comfort during the transfusion," she told Medscape Medical News.

Gholz added that she will be presenting the data from this study to her transfusion committee soon.

The study was sponsored by University of Colorado Hospital. Ms Hendrickson and Ms Gholz have disclosed no relevant financial relationships.

Oncology Nursing Society (ONS) 40th Annual Congress: Abstract 83. Presented April 25, 2015.

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