Kennedy, Case, Hurd, Cruz, and

¶ … Kennedy, Case, Hurd, Cruz, and Pomper, 2008) was to prospectively compare the risk of transfusion reactions in hematology/oncology patients who receive acetaminophen with diphenhydramine or placebo before transfusion. This study hypothesized that patients who were given acetaminophen with diphenhydramine were less likely to show transfusion related reactions. This should show up in those given the actual drug, using those with the placebo as the control group.

Study research variables are as follows, Independent: The dosing of the patients with the drug or the placebo and Dependent: The patient reaction and metabolization of the dosing. This study was designed as a randomized, double-blind study intended to show whether or not the inclusion of specific drug dosings would alter the effect of transfusion related reactions. This study represents a Level II correlational survey/comparative survey. The sample number was 315 active patients from a total of 334 initial patients admitted for the study.

Patients' ages ranged from 18-65 years of age and there were no gender limitations. The health status of the sample population were all admitted to leukemia or bone marrow transplant services the study took place in a hospital setting located in the Comprehensive Cancer Center of Wake Forest University (Kennedy, Case, Hurd, Cruz, and Pomper, 2008). The major findings of the study include, as worded in the final report, "Pretransfusion medication of leukemia or BMT patients without a history of transfusion reaction does not decrease the overall risk of transfusion reactions.

However, pretransfusion medication may decrease the risk of febrile nonhemolytic transfusion reactions to leukoreduced blood products." (Kennedy, Case, Hurd, Cruz, and Pomper, 2008). The quality of the study evidence is relatively high, given that 154 of the 315 patients were dosed with the drug and the remainder was given the placebo. The correlating graphed information relative to the study also shows a direct correlation between the number of transfusions and the risk for reaction.

The study results were significant in showing that the drug had no real value in helping to reduce the risk of transfusion related reactions, at least in the method in which was studied. Analysis and Arguments According to the editorial which appeared in the same issue of Transfusion (Tobian, King, and Ness, 2008), the study conducted relative to the use of acetaminophen and diphenhydramine pretransfusion medication vs.

placebo for the prevention of transfusion reactions was a direct answer to the fact that much of what is known about these drugs helping to prevent a reaction in a transfusion came from 60-year-old information that was not correlated at all with any study or scientific analysis of whether or not these drugs did anything at all to reduce the prevalence of reactions in the populations must susceptible to them.

The editorial does much in exposing some of the weaknesses and points of contention within the medical field pertaining to the use of such drugs for reducing reactions in transfusion. The editorial (Tobian, King, and Ness, 2008) also mentions that in 3 out of 4 studies over the past 10 years, there has been no direct correlation between the administering of these drugs and the reduction in reactions related to transfusions.

Also, the only study that was ever conducted that assessed the effectiveness of pretransfusion medications was conducted on 15 patients, hardly a large enough sample to draw any real correlation between these two assumptions. The alarming issue at hand is the fact that the drugs acetaminophen and diphenhydramine are not administered without risk, and the fact that they are commonly used without any real clinical study basis for their usage only hurts the credibility of those medical professionals who advocate for their dosing.

Tobian, King, and Ness (2008, 2275) conclude their editorial by stating, "In the absence of definitive evidence-based studies, pretransfusion medication to prevent transfusion reactions should not be encouraged. Transfusion medicine specialists should resist efforts to make pretransfusion medication with these agents standard therapy in automated physician order entry systems." This is a very strong statement relative to the subject of administering these drugs to help prevent reactions in transfusions.

This hard line stance coming from these medical professionals reflects the fact that these drugs have yet to be fully tested as agents for reducing transfusion related reactions, and therefore, according to the authors of the editorial, should not be used until being further evaluated. The Geiger and Howard article (2007) takes an entirely different stance on the issue. They feel that the pretransfusion use of acetaminophen and diphenhydramine has some basis in biology, if not in clinical studies.

This comes from the fact that these drugs reduce fever and the propensity for allergic reactions in patients when taken for other ailments, and that these characteristics alone serve to justify their use as a prophylaxis for similar conditions related to transfusions (Geiger and Howard, 2007). The authors believe that the toxicity of these drugs however can be a negative aspect when administered to patients who are particularly ill, and who would otherwise not likely benefit from these drugs being administered in the first place for other similar reactions or ailments.

This is an interesting stance because it shows the ability for medical professionals to understand that the biology and characteristics of a drug likely present some benefit to pretransfusion patients in reducing the potential for reactions, but that the lack of clinical trial-based evidence does not specifically rule out the use of these drugs, it only suggests that they should be administered in moderation and under the best intentions and understandings of the health care professionals whose care is being provided to the patients in question.

Within a secondary study of the fibrile nonhemolytic transfusion reactions themselves, the evidence for including the drugs acetaminophen and diphenhydramine in a pretransfusion dosage yielded results supporting the fact that these drugs help the patients more than thy could potentially hurt them, yet the administering of these drugs does not have any direct cost benefit to the healthcare provider themselves (Ezidiegwu, Lauenstein, Rosales, Kelly, and Henry, 2004).

This attitude is interesting since much of the medical world relies on evidence-based change in their practices and does not condone the use of medicines or procedures for their prophylaxis exclusively. Furthermore, authors Rosswurm and Larrabee (1999) are quick to argue that the best model for providing adequate and accurate healthcare is one that is based in evidence. This means that.