This is the largest double-blind randomized controlled trial designed to determine the utility of tylenol and diphenhydramine in reducing the incidence of allergic or febrile non-hemolytic transfusion reactions (abstract). Included patients were those admitted to a leukemia or BMT unit with no prior transfusion reaction, and all transfusions were leukoreduced. They found the incidence of reactions was 1.5/100 transfusions in the placebo group and 1.4/100 transfusions in the intervention group. Based on this (and other smaller and older trials), there is no benefit to pre-meds in cancer patients receiving leukoreduced transfusion products. As an editorialist states, it would be nice to see corroboration in a more general medical population, but for now, routine pre-med use should be discouraged (editorial)
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