輸血引起不良反應， 以發熱性非溶血性輸血反應 (febrile nonhemolytic transfusion reactions) 與過敏反應 (allergic reaction) 較為常見，如有發生，可透過給予乙醯氨酚或抗組織胺緩解，或是使用減除白血球之血品預防。然而，無論是指引或專家意見，對於輸血前給予抗組織胺或乙醯氨酚以減少輸血不良反應的發生風險並無共識。因此本文以臨床案例與實證方式探討輸血前是否建議給予抗組織胺或乙醯氨酚以預防發燒或過敏。王先生為60 歲男性，患有白血病 (leukemia)，已接受骨髓移植(bone marrow transplantation)，目前仍須透過輸減白紅血球濃縮液 (leukocyte-poor red blood cell) 與任意給血者血小板 (random donor platelet)，維持正常的血液含氧及避免器官出血。有次輸血時發生過敏反應與發燒，醫師在王先生發生症狀後，處方抗組織胺與乙醯氨酚緩解他的不適，王先生害怕這次輸血又會發生同樣的狀況，諮詢醫師可否在輸血前就給藥，以有效避免症狀的發生？透過PICO (Patient/Problem, Intervention, Comparison, and Outcome) process 提出臨床問題，執行檢索策略並篩選文獻後，由1 篇系統性回顧作為最佳證據，且額外納入1 篇隨機對照試驗作為證據補充。系統性回顧效度為良好，隨機對照試驗為some concerns。結果的數據顯示，輸血前給予抗組織胺或乙醯氨酚，無法預防輸血不良反應之發生，GRADE (Grading of Recommendations Assessment, Development, and Evaluation) 評估證據品質結果為低與非常低，利與弊的衡量中，事先給藥不會帶來好處，反而會增加藥物不良反應的可能性發生，但考量王先生曾經有輸血不良反應的經驗，產生心理焦慮，綜合考量仍薄弱建議輸血前給藥。

 

Transfusion reactions, such as febrile nonhemolytic transfusion reactions and allergic reactions, are common and can be treated with the administration of acetaminophen or antihistamines, or by using leukocyte-poor blood products for prophylaxis. However, no consensus has been reached in guidelines or expert opinions regarding the administration of antihistamines or acetaminophen prior to transfusion to reduce the risk of transfusion reactions. Through evidence-based methods and clinical scenarios, this article explores whether antihistamines or acetaminophen should be recommended to prevent fever or allergies before blood transfusion. Wang, a 60-year-old man with leukemia, had undergone bone marrow transplantation and required the transfusion of leukocyte-poor red blood cells and platelets from random donors to maintain normal blood oxygenation and prevent organ bleeding. He experienced an allergic reaction and fever during the blood transfusion. The doctor prescribed antihistamines and acetaminophen to relieve his discomfort after the symptoms appeared. The patient expressed concerns that the same reaction would occur in every transfusion, so he consulted whether premedication is effective. After exploring clinical questions through the Patient/Problem, Intervention, Comparison, and Outcome (PICO) process, conducting searches, and screening the literature, we performed a systematic review to determine the best evidence and utilized a randomized controlled trial as supplementary evidence. The validity of the systematic review was high, but the randomized controlled trial raised some concerns. The results indicate that antihistamines or acetaminophen administered before blood transfusion cannot prevent adverse reactions. The quality of evidence, as assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), was rated as very low to low. However, if the patient still fears experiencing a transfusion reaction, premedication should still be recommended before blood transfusion.

 

Submitted for publication: 2022.12.15; Accepted for publication: 2023.6.7