明智選擇：不需於輸血前常規使用抗組織胺

Choosing Wisely: Antihistamine Should Not Be Routinely Applied Before Blood Transfusion

輸血是外科最常見的處置之一，臨床上許多醫師常習慣性在輸血前合併開立抗組織胺藥物，目的是為了減少輸血反應的發生。過去許多醫學證據顯示，輸血前給予抗過敏藥物或是退燒藥，並無法有效減少發熱性非溶血性輸血反應或過敏反應的發生，因此決定由外科開始推動減少輸血前常規使用抗組織胺藥物。

我們先針對此問題進行歷史回溯找出近3年之實境資料，進而根據資料分析結果，向科部內成員宣導毋需常規於輸血前使用抗組織胺藥物的概念。初步結果顯示目前於外科部輸血前使用抗組織胺藥物的比例已大幅降低，而且發生輸血反應的比例也沒有因此而增加。我們將持續推廣此概念，希冀更明智抉擇地進行輸血實務作業。

 

Transfusion is one of the most common procedures in surgical departments. Some surgeons routinely prescribe antihistamines before blood transfusion to reduce the risk of transfusion reactions. The most frequent adverse effect of blood transfusion is a febrile nonhemolytic transfusion reaction or an allergic reaction. However, evidence has demonstrated that applying antihistamines or antipyretic agents before transfusion does not reduce the incidence of transfusion reactions. The "Choosing Wisely campaign" should be advocated in surgical departments because restricting the routine prescription of antihistamines before blood transfusion is a favorable outcome.

Retrospective data from the past 3 years were collected, which indicated that premedication with antihistamines did not reduce the incidence of transfusion reactions. The results of data analysis suggested that the protocol of not routinely prescribing antihistamines before blood transfusion has been promoted among all members of the surgical department. Through such promotion, the number of antihistamine prescriptions before blood transfusion in surgical wards was reduced; the incidence of blood transfusion reactions did not increase, indicating the safety of this protocol. We recommend continuing to promote this concept to other medical personnel as "choosing wisely."