Objective: To determine how current hospital practice for transfusions of red cells, platelets and fresh frozen plasma conformed with published criteria. Design: Elaboration of criteria for transfusion from a review of the current literature; and analysis of the medical records of patients receiving transfusions of red cells (200), platelets (215), and fresh frozen plasma (260) during defined time periods in 1993. Setting: A large tertiary care teaching hospital. Outcome measures: Inappropriateness rates for transfusion episodes and numbers of individual units of blood products administered. Results: Inappropriateness rates for transfusion episodes and numbers of individual units administered were 16% and 10% for red cells, 13% and 11% for platelets, and 24% and 16% for fresh frozen plasma (31 % and 21% when transfusions for thrombotic thrombocytopenic purpura were excluded). Red cells and fresh frozen plasma were used inappropriately most frequently in association with a surgical procedure; for platelets, it was their use for bleeding. In many of the transfusions deemed inappropriate, deficiencie of red cells, platelets and/or coagulation factors were documented, but the degree of deficiency did not meet the stringent appropriateness criteria. Twentysix transfusions were deemed inappropriate because the indication was not documented in the medical record. Conclusions: Specific problem areas in which blood product use was inappropriate were identified. Guidelines for transfusion appropriateness, education of hospital staff, and a monitoring system to ensure adherence to the guidelines, are required.
In recent years, the anti-CD38 monoclonal antibody daratumumab (Darzalex; JanssenCilag Pty Ltd) has been shown to be highly efficacious in relapsed and refractory multiple myeloma, with the final results of treatment in newly diagnosed patients awaited. Despite awareness of the potential interference of daratumumab in pre-transfusion immunohaematology testing during phase I and II clinical studies, there was a degree of unpreparedness in the community upon the introduction of this drug into the clinics, particularly the impact that it has on the operational processes in hospital transfusion laboratories and timely issue of red blood cells (RBCs). Anti-CD38 interference in pre-transfusion immunohaematology tests is a particular problem in patients being treated with daratumumab for multiple myeloma as many will require RBC transfusions during their disease treatment. Panagglutination caused by anti-CD38 monoclonal antibody during the indirect antiglobulin test may mask the presence of a clinically significant RBC alloantibody in the patient's plasma during the antibody screen and identification process, which may be overlooked, particularly in urgent situations, subsequently resulting in a delayed or acute haemolytic transfusion reaction. Here, we summarise daratumumab's effects on pre-transfusion immunohaematology testing and its impact on clinical practice and make practical recommendations based on a consensus from medical and scientific transfusion experts and myeloma specialists on behalf of the Australian and New Zealand Society of Blood Transfusion and Myeloma Scientific Advisory Group to Myeloma Australia, respectively.
BACKGROUND: To accurately quantify the costs of care for patients with transfusion-dependent thalassemia (TDT), and to evaluate cost-effectiveness of new treatments, data are required on costs of regular red blood cell (RBC) transfusions. However, no previous studies have evaluated the costs of RBC transfusion specifically in chronically transfused patients. P atients with transfusion-dependent thalassemia (TDT) require lifelong, regular red blood cell (RBC) transfusions to improve anemia and to suppress ineffective erythropoiesis and subsequent complications, such as splenomegaly, skeletal abnormalities, increased dietary iron absorption, and thrombosis. 1,2 Transfusing RBCs every 2 to 5 weeks has been shown to maintain the balance between inhibition of erythropoiesis and transfusion-related iron overload. 2 Allogeneic stem cell transplantation is the only current definitive cure for TDT; however, this procedure is limited by availability of matched donors and the risk of graft-versus-host disease. Encouragingly, many new therapeutic approaches with potential to transform management of β-thalassemia are currently being evaluated in clinical trials. ABBREVIATIONS: MMC = Monash Medical Centre; MTU = Medical Therapy Unit; TDABC = time-driven activity-based costing; TDT = transfusion-dependent thalassemia. From the
Detailed process maps using bottom-up, time-driven, activity-based costing for determining the cost of RBC transfusion in thalassaemia major have been developed. These could be adapted for wider use to understand and compare the costs and complexities of transfusion in other settings.
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