全面性輸血前用藥不能有效降低非感染性輸血反應

Universal Pretransfusion Medication Cannot Reduce Noninfectious Transfusion-Associated Adverse Reactions

許鈴宜(Ling-I Hsu) ； 程仁偉(Jen-Wen Chen) ； 侯勝茂(Sheng-Mou Hou)

《台灣醫學》 27卷3期 (2023/05) Pp. 249-258

https://doi.org/10.6320/FJM.202305_27(3).0001

摘要

輸血是常見且關鍵的醫療處置，但輸血亦有可能引發不良反應。輸血反應包括感染性及非感染性，常見的非感染性輸血不良反應，包括發熱性非溶血性輸血反應及紅疹、蕁麻疹等過敏反應。雖然上述反應未造成生命威脅，但仍增加醫療院所管理及照護之負擔。自1950年代，輸血前藥物介入開始被用於降低輸血引起的發燒及過敏反應，但自從減除白血球血品（減白血品）的問世，使用減白血品亦能有效降低非溶血性輸血不良反應。依據近期臨床試驗及統合分析，病患若輸用減白血品，輸血前使用解熱鎮痛藥物，無法顯著降低輸血引起的發燒，使用抗過敏藥物或類固醇藥物，亦無法降低過敏反應的發生率。在台灣正式邁入全面使用儲存前減白紅血球的時代，輸血前藥物的介入措施，可考慮只針對具過敏性疾病史，或輸血反應史等特定族群使用。

關鍵字

非感染性輸血不良反應 ； 發熱性非溶血性輸血反應 ； 輕微性過敏反應 ； 藥物介入 ； 減除白血球血品

並列摘要

Blood transfusion is one of life-saving therapies. However, they may be accompanied by several adverse events including infectious and noninfectious outcomes. The most common noninfectious reactions include febrile nonhemolytic transfusion reactions and allergic transfusion reactions. Although the symptoms of these reactions can be mild, the management of these events represents a substantial burden on hospital and patient care. Since 1950s, pretransfusion medications have been adopted to reduce febrile nonhemolytic and allergic transfusion reactions. After a development of leukoreduction for blood components, it becomes the primary mitigation strategy to prevent nonhemolytic transfusion reactions. Based on randomized clinical trials and recent meta-analysis, no evidence supports the efficacy of routine prophylaxis with antipyretics for febrile nonhemolytic transfusion reactions, and with antihistamine or glucocorticoids for allergic transfusion reactions when applying leukocyte-reduced blood components. In Taiwan, in the era of universal prestorage leukoreduction of red blood cells, we suggest the use of pretransfusion medications may restrict to high-risk population with a history of transfusion reactions or allergic reactions.

並列關鍵字

noninfectious transfusion-associated adverse event ； febrile non-hemolytic transfusion reaction ； minor allergic reaction ； pretransfusion medications ； leukoreduction