Improvements in transfusion medicine, blood typing, and donor screening have reduced the likelihood of a reaction from administration of blood products. In an effort to prevent transfusion reactions, our current standard is to administer acetaminophen 650mg and diphenhydramine 25mg, 30 minutes before transfusions. This practice may unnecessarily place patients at increased risk for complications including falls, cognitive impairment, and hepatic toxicity. P=Adult BMT/oncology patient; I=Does the prophylactic use of acetaminophen and diphenhydramine; C=versus no premedication; O=affect the incidence of blood transfusion reactions? The evidence based practice committee (EBPC) at a comprehensive cancer center in the Midwest conducted a literature review to determine if evidence supported the efficacy for reducing transfusion reactions with routine premedication utilizing acetaminophen and diphenhydramine. The search strategy included electronic searches of numerous resources including PubMed (MEDLINE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Medline, Elton B. Stephens Company (EBSCO), Ovid, and Scopus to gather established information. The results of one prospective, randomized, double-blind, placebo-controlled and two retrospective reviews were analyzed and failed to show any benefit to premedication prior to transfusion of blood products. Based on the evidence, the EBPC sought to obtain a baseline rate of transfusion reaction at their facility. Between January and April 2014, a retrospective review was conducted on 137 transfusion patients to determine the frequency of transfusion-related reactions. Four transfusion reactions were reported; all four patients had been premedicated prior to transfusion. Six patients did not receive any premedication; none of which had a transfusion-related reaction. The chair of the EBPC presented these findings at BMTQI. Committee concerns included the possible increase in confounding febrile reactions that might lead to unnecessary admissions and febrile transfusion reaction work-ups. A compromise was reached with the BMTQI committee approving the elimination of Benadryl as a routine premedication. Next steps will include implementation of this new protocol with additional data collection on rate of transfusion reactions for the next three months. If results concur with reviewed evidence, this protocol change will be expanded across the facility and can be a platform for other centers who are still using premedication.

After performing thousands of bone marrow biopsies (BMX), our nurse lead biopsy staff started identifying what is likely intuitively known about specific diseases and their BMX characteristics. We began collecting data both on core lengths and hemodilution rates to see if our data validates our suspicions that patients with plasma cell dyscrasias (PCD) have significantly smaller core lengths and myeloproliferative disorders (MPD) have significantly higher hemodilution rates. This was a chart review from pathology reports on 3199 patients with BMX's performed at Siteman Cancer Center between January 1st 2006 and December 30th 2011. A convenience sample of patients having their BMX at our center was utilized. We reviewed patients BMX results a week following the BMX procedure to monitor job performance of the BMX staff. Data collected included diagnosis, gross bone marrow core length, evaluable bone marrow core, and pathology reported bone marrow aspirate hemodilution. For this review PCD included MM, Monoclonal gammopathy of undetermined significance (MGUS), and Amyloidosis. MPD included Chronic Myeloid Leukemia (CML), Polycythemia Vera (PV), and Myelofibrosis (MF). Our data showed that the mean bone marrow core length among all samples was 1.9 centimeters (cm) with the average evaluable bone marrow core length being 1.3 cm. Mean PCD bone marrow core length was found to be much lower at 1.6 cm with evaluable core length of 1.1 cm. Our mean hemodiluted bone marrow aspirates rate was 12.2%. The percent of CLL hemodiluted bone marrow aspirate was 15.4% which included 2 dry taps and MPD was 17.3% and included 1 dry tap. Of interest, the percent of hemodiluted samples seen in patients with Mastocytosis was 55.6%. In reviewing our data, we noted that only 19 of 3199 patients had a dry tap which seems quite low. It is our thought that this is a reflection of the patient population we treat. Most of the newly diagnosed AML's have their BMX in the hospital. See chart for full data compilation. In our review, it appears that plasma dyscrasias have a bone marrow core less than the average reviewed and CLL, MPD, and Mastocytosis have a higher hemodilution rate in comparison. We are going to review the data further to see if differences can be seen in older vs. younger patients.Tabled 1TOTALALLAAAMLCLLMPDHDMDSMastoPCDNHLOtherTotal Bone Marrow Biopsies3199170549651252157831732598508137Average Core in Centimeters1.91.91.91.91.91.92.01.82.01.62.01.9Average Evaluable Core in CM.1.31.41.41.31.41.31.61.31.51.11.61.3% per Captured41.1%5.3%1.7%30.2%3.9%6.7%2.4%9.9%1.0%18.7%15.9%4.3%% Hemodiluted per Aspirates12.2%9.4%11.9%12.3%15.4%17.3%7.8%10.2%55.6%9.1%6.7%15.7%Drytab1900321121531 Open table in a new tab