A retrospective study evaluating single‐unit red blood cell transfusions in reducing allogeneic blood exposure

Abstract

Although guidelines recommend the use of single-unit red blood cell (RBC) transfusions to minimize allogeneic blood exposure, clinical practice remains dominated by two-unit transfusions. This study assesses the potential impact of a single-unit transfusion policy on reducing RBC utilization. We performed a retrospective analysis of adult patients admitted to a tertiary care hospital who received one or two RBC units. In subjects transfused two units, the effect of one unit was estimated by dividing the change in haemoglobin by 2. The proportion of patients reaching a haemoglobin threshold of 70, 75, 80, 85 and 90 g L(-1) with a single RBC unit was estimated. Of 302 included patients, only 65 received a one-unit transfusion. Based on thresholds of > or = 90, > or = 80 and > or = 70 g L(-1), a single-unit transfusion would be sufficient in 42.0% (RRR = 0.54), 79.6% (RRR = 0.23) and 98.0% (RRR = 0.02) of cases, respectively. This corresponds to 0.21, 0.57 and 0.82 mean RBC units saved per patient. In the orthopaedic subpopulation, the mean RBC units saved are 0.53, 0.88 and 1.00 for the same haemoglobin targets. Adopting a policy of transfusing RBC in single-unit aliquots could significantly improve RBC utilization and decrease patient exposure to allogeneic blood.

Significant reduction of red blood cell transfusion requirements by changing from a double-unit to a single-unit transfusion policy in patients receiving intensive chemotherapy or stem cell transplantation

“…One more recent study theoretically analyzed the effect of transfusing only one RBC unit at a time, concluding that a single-unit RBC transfusion strategy has considerable potential to save RBC units and that this is more pronounced when applying lower transfusion triggers. 8 Our current study analyzed for the first time two cohorts of patients who were subjected to either transfusion policy, thus avoiding the selection bias of earlier studies. The limitations of the study are its retrospective, single-center nature, the lack of standardized bleeding assessments and the lack of a quality of life assessment of the patients during the therapy.…”

“…During these cycles 213 RBC units were administered, which is 14% of the total RBC units. There was no significant difference in the number of therapy cycles with severe bleeding episodes between the double-unit period (n=7, 5.2%) and the single-unit period (n=11, 8.0%, P=0.362) and the median number of platelets transfused per therapy cycle was five (2-9) and five (3)(4)(5)(6)(7)(8)(9) in the double-and single-unit periods, respectively (P=0.896).…”

“…Fifteen of these therapy cycles were for allogeneic HSCT with reduced-intensity conditioning (n=7) or myeloablative conditioning (n=8). The median aplasia time in this group was 8 days (IQR, [5][6][7][8][9][10][11][12] The effect of the single-unit red blood cell transfusion policy…”

“…Reducing the volume per transfusion may save a considerable number of RBC units thereby reducing the patients' exposure to allogeneic blood products. 8 However, despite a lack of studies, most guidelines recommend double-unit transfusions, while only a few, more recent guidelines allow single-unit RBC transfusions in the absence of active bleeding. [9][10][11][12][13][14] Nonetheless, surveys on transfusion practices have shown that more than 90% of physicians currently transfuse two RBC units simultaneously showing that they have not yet implemented this new transfusion policy.…”

Use of Blood and Blood Components In Dhaka Medical College Hospital

“…18 Rational use of blood implies that right blood product is to be given to the patient only when needed and in the right amount. 19 Therefore, it is essential to look into the existing blood transfusion practices and collect background information about the type of existing blood transfusion practices e.g. requests for single-unit transfusion, fresh blood transfusion, use of whole blood etc.…”