Effect of premedication guidelines and leukoreduction on the rate of febrile nonhaemolytic platelet transfusion reactions

Platelet transfusion reactions were prospectively studied in haematology/on cology patients at five university teaching hospitals over three consecutiv e summers. The initial summer study provided baseline information on the us e of premedications and the rate of platelet transfusion reactions (fever, chills, rigors and hives). Most (73%) platelet recipients were premedicated and 30% (95% CI 28-33%) of transfusions were complicated by reactions. The second study followed implementation of guidelines for premedicating plate let transfusions. Despite a marked reduction in premedication (50%), there was little change in the platelet transfusion reaction rate, 26% (95% CI 24 -29%), or the type of reactions. The third study followed implementation of prestorage platelet leukoreduction while maintaining the premedication gui delines. The reaction rate decreased to 19% (95% CI 17-22%). For nonleukore duced platelets, there was a statistically significant association between the platelet age and reaction rate (P = 0.04). For leukoreduced platelets, there was no statistically significant association between platelet age and reaction rate (P = 0.5). Plasma reduction of nonleukoreduced platelet prod ucts also reduced the reaction rate. These prospective studies document a h igh rate of platelet transfusion reactions in haematology/oncology patients and indicate premedication use can be reduced without increasing the react ion rate. Prestorage leukoreduction and/or plasma reduction of platelet pro ducts reduces but does not eliminate febrile nonhemolytic platelet transfus ion reactions.