Primary prevention

The key to preventing any transfusion reaction is adherence to existing safety protocols and checklists when transfusions are administered, and minimizing the frequency of blood transfusion by utilizing a pragmatic and patient-specific transfusion threshold.[4][6][31]

Secondary prevention

  • Although prophylactic acetaminophen is often routinely administered to prevent febrile nonhemolytic transfusion reactions, there is little evidence in the literature to support this practice.[4][17][55]

  • Pre-storage leukoreduction has been demonstrated to significantly decrease the incidence of febrile nonhemolytic transfusion reactions.​[1][6][56] In many countries, universal leukoreduction of the blood supply has been implemented. To date, this is not the case in the US. 

  • Premedication with antihistamine is often administered to prevent allergic reactions but there is little evidence in the literature to support this practice.[1][17][55][57] Nonetheless, premedication with diphenhydramine may be helpful in patients with a history of recurrent moderate or severe allergic reactions to transfusion.[1]​ Transfusion of washed components to such patients should also be considered.[1][21]

  • Plasma transfusions for patients with known IgA deficiency (and who produce anti-IgA antibody) should come from IgA-deficient donors.[6][21] Red cells and platelets should undergo pretransfusion washing, which effectively removes the plasma proteins.[1][6][21]

  • Patients with a history of post-transfusion purpura should receive future components from antigen-matched donors.[6]​ This should be done in consultation with a blood bank.[21]

  • Risk factors for transfusion-associated graft-versus-host disease include leukemia or lymphoma, treatment with immunosuppressive drugs, congenital immunodeficiency, or neonatal status.[9][40]Patients should receive components that have undergone irradiation prior to transfusion. Irradiation eliminates the lymphocytes responsible for the cell-mediated immune response that causes graft-versus-host disease.[9][30]

  • Hypothermia is associated with large-volume transfusions. This can be avoided by warming blood components.[4][53]

  • As WBC antibodies are much more prevalent in female than in male donors, a strategy to prevent transfusion-related acute lung injury (TRALI) is to exclude females from the plasma donor pool.[4]​ Since the UK first started to exclude plasma from female donors for transfusion in 2004, several other countries have implemented, or are considering implementing, this policy to prevent TRALI.[58] Although effectiveness has not been proven, this approach is supported by recent systematic reviews.[59][60]​​[61]

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