Acetaminophen and Chlorpheniramine Maleate Premedication among Patients with Chronic Transfusion: a Prospective, Randomized Controlled Trial
DOI:
https://doi.org/10.69898/jhtm.v342024Keywords:
premedication, leucocyte poor packed red cell, transfusion reactionAbstract
Introduction: Patients with chronic transfusion, especially those with transfusion-dependent thalassemia, are
susceptible to transfusion reactions. Acetaminophen and/or chlorpheniramine maleate (CPM) are commonly
used as premedication in Thailand, although their efficacy in preventing transfusion reactions remains unclear.
This study aims to evaluate the efficacy of acetaminophen and CPM in preventing febrile nonhemolytic
transfusion reaction (FNHTR) and allergic transfusion reaction (ATR) before leukocyte-poor packed red cells
(LPRC) transfusion.
Methods: This study is a prospective, randomized controlled trial involving patients with chronic transfusion
aged 18 years. Patients were randomly assigned to either receive oral acetaminophen and intravenous CPM
or placebo (calcium carbonate and normal saline) before LPRC transfusion. The primary endpoint was the
combined incidence of FNHTR and ATR amongpatients receiving premedication compared with those
receiving placebo. This study was registered at Thai Clinical Trial Registry Study ( TCTR20221011002).
Results: Ninety-four patients were recruited, with 46 in the premedication arm and 48 in the placebo arm. The
incidence of FNHTR and allergic transfusion reaction in the premedication arm and the placebo arm was 0%
and 2.1%, respectively (P = 0.33). FNHTR occurred in one patient in the placebo arm, and no patients
presented ATR. No adverse events were reported with any medication.
Conclusions: Among patients with chronic transfusion receiving LPRC, the incidence of FNHTR or ATR is
low. Premedication with oral acetaminophen and intravenous CPM did not have benefits in preventing
transfusion reactions. Therefore, acetaminophen and CPM could be safely omitted in chronic transfused
patients without a history of transfusion reactions
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