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Medication

Medication Summary

Use an antihistamine to ameliorate allergic reactions to plasma. These agents serve as adjuncts to epinephrine and other standard measures for therapy of anaphylaxis related to transfusions of plasma-containing blood products.

Analgesics and antipyretics reduce fever that is associated with nonhemolytic transfusion reactions. An osmotic diuretic promotes urinary excretion of hemoglobin that results from an acute hemolytic transfusion reaction.

Class Summary

Antihistamines prevent histamine response in sensory nerve endings and blood vessels. These agents are more effective in preventing histamine response than in reversing it.

Diphenhydramine hydrochloride (Benadryl, Diphen)

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Antihistamine with anticholinergic effects that competes with histamine for receptor sites on effector cells. Among other indications, used to treat urticaria, pruritus, and other histamine-mediated manifestations of allergic reactions to blood products.

Class Summary

Analgesics and antipyretics improve patient comfort and reduce fever.

Acetaminophen (Tylenol, Panadol)

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Nonopiate, nonsalicylate analgesic and antipyretic. Reduces fever by acting directly on hypothalamic heat-regulating centers, which increase dissipation of body-heat via vasodilation and sweating.

Class Summary

Osmotic agents increase the osmolarity of the glomerular filtrate and induce diuresis. This, in turn, hinders the tubular reabsorption of water, also causing sodium and chloride excretion to increase.

Mannitol injection 20% USP (Osmitrol)

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An obligatory osmotic diuretic only slightly metabolized and excreted by the kidney. Induces diuresis by increasing the osmolarity of the glomerular filtrate, thereby hindering tubular reabsorption of water. Excretion of sodium and chloride is also enhanced.

Class Summary

Vasopressors are used to reverse the hemodynamic compromise that is associated with anaphylaxis or allergic reaction.

Epinephrine (Epi-Pen, Adrenaline)

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A sympathomimetic that activates both alpha receptors and beta receptors. Causes bronchial smooth muscle relaxation and cardiac stimulation.

Dopamine (Intropin)

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An immediate precursor to epinephrine, dopamine stimulates dopaminergic, beta-adrenergic, and alpha-adrenergic receptors.

Class Summary

Diuretics may be used to alleviate volume overload that is caused by transfusion of blood products.

Furosemide (Lasix)

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Acts by inhibiting sodium and chloride resorption in the ascending loop of Henle, promoting excretion of sodium, water, chloride, and potassium.

Questions

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Media Gallery

Rapid test to distinguish hematuria from hemoglobinuria. The onset of red urine during or shortly after a blood transfusion may represent hemoglobinuria (indicating an acute hemolytic reaction) or hematuria (indicating bleeding in the lower urinary tract). If freshly collected urine from a patient with hematuria is centrifuged, red blood cells settle at the bottom of the tube, leaving a clear yellow urine supernatant. If the red color is due to hemoglobinuria, the urine sample remains clear red after centrifugation.

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Author

S Gerald Sandler, MD, FCAP, FACP Professor Emeritus of Medicine and Pathology, Georgetown University School of Medicine

S Gerald Sandler, MD, FCAP, FACP is a member of the following medical societies: American Association of Blood Banks, College of American Pathologists, International Society of Blood Transfusion

Disclosure: Nothing to disclose.

Coauthor(s)

Viviana V Johnson, MD Medical Director, Blood Bank, Naval Medical Center, Portsmouth

Viviana V Johnson, MD is a member of the following medical societies: American Association of Blood Banks, College of American Pathologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ronald A Sacher, MD, FRCPC, DTM&H Professor Emeritus of Internal Medicine and Hematology/Oncology, Emeritus Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MD, FRCPC, DTM&H is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Pradyumna D Phatak, MBBS, MD Chair, Division of Hematology and Medical Oncology, Rochester General Hospital; Clinical Professor of Oncology, Roswell Park Cancer Institute

Pradyumna D Phatak, MBBS, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Received honoraria from Novartis for speaking and teaching.

Acknowledgements

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.

Transfusion Reactions Medication

Medication Summary

Antihistamines

Class Summary

Diphenhydramine hydrochloride (Benadryl, Diphen)

Diphenhydramine hydrochloride (Benadryl, Diphen)

Analgesics and Antipyretics