A patient-centric approach to preventing allergic reactions to platelet transfusions.

摘要

Allergic transfusion reactions (ATRs) are the most common transfusion complications. Although usually they are not serious, cumulatively they can amount to significant morbidity for the multiply transfused hospitalized patients who are the sickest of all patients. ATRs are attributed to a Type I hypersensitivity reaction mediated by preformed recipient antibody directed to an "allergen" in the transfused product. In practice, however, there is usually no identified culprit(s), and the ATR appears to involve an interaction between unspecified recipient and product (including donor) factors. To prevent ATRs, diphenhy-dramine is administered before more than half of the transfusions given in the United States, despite the fact that pretransfusion medication with 25 mg of diphenhy-dramine was found not to prevent ATRs in two randomized controlled trials (RCTs). Thus, although ATRs accompany 1% to 3% of all transfusions, the pathogenesis of ATRs remains poorly understood and effective prevention of ATRs eludes us.