ABSTRACT
You will not prevent every febrile non-hemolytic transfusion reaction with pre-medication with acetaminophen, so do not order it on all your patients. Many physicians have been taught that pre-treating patients with 650 mg acetaminophen and 25 mg diphenhydramine per os prior to transfusion is a standard order, and one which will likely prevent the development o f that minor fever which inter rupts a transfusion. When a patient develops a fever during a transfusion, you are called to the bedside to evaluate him/her when you have many other patient-care tasks to complete already, and the transfusion o f needed blood is delayed while the Blood Bank does the reaction work up. Better to avoid this if at all possible, right? Yes, but...pre-medication with acetaminophen does not really blunt the febrile reaction. Tobiahs 2007 review on this topic showed that the rates o f febrile non-hemolytic transfusion reactions (FN H T R ) and allergic reactions (ATR) to be similar, or even increased with pre-medication (Transfusion article). The largest study reviewed found a rate o f 17.8% (FN H T R + ATR) in the treatment group vs. 19.3% in the controls. I suggest that you avoid ordering acetaminophen except in the following situation: if your patient has an established fever prior to transfusion, acetaminophen may dampen the fever curve long enough for you to complete the transfusion without a spike that will cause the transfusion to be interrupted. This might be a neutropenic fever patient on the oncology ward or a postoperative patient with an infection. Order it then. For all other patient’s it’s reasonable to skip the acetaminophen. If they develop a fever, then give it; you probably would N O T have avoided this situation anyway.
