Comparing the safety and efficacy of red blood cell transfusion dose in hematopoietic stem cell transplant patients: single versus double unit transfusions

Evans, Rhonda; Avdić, Aldijana; Smith, Anne Marie; Tucker, Sharon

doi:10.1016/j.bbmt.2013.12.140

Cited by 2 publications

(3 citation statements)

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“…Observational studies suggest that this strategy is safe and results in decreased red cell utilization. 41,42 However, such studies have not evaluated the impact of a single unit transfusion strategy in the context of HRQOL. Fourth, despite randomisation the duration of storage of transfused red cells was statistically different between the 2 arms of the study.…”

Section: Discussionmentioning

confidence: 99%

Liberal Versus Restrictive Red Blood Cell Transfusion Thresholds in Hematopoietic Cell Transplantation: A Randomized, Open Label, Phase III, Noninferiority Trial

Tay

Allan

Chatelain

et al. 2020

JCO

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PURPOSE Evidence regarding red blood cell (RBC) transfusion practices and their impact on hematopoietic cell transplantation (HCT) outcomes are poorly understood. PATIENTS AND METHODS We performed a noninferiority randomized controlled trial in four different centers that evaluated patients with hematologic malignancies requiring HCT who were randomly assigned to either a restrictive (hemoglobin [Hb] threshold < 70 g/L) or liberal (Hb threshold < 90 g/L) RBC transfusion strategy between day 0 and day 100. The noninferiority margin corresponds to a 12% absolute difference between groups in Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) score relative to baseline. The primary outcome was health-related quality of life (HRQOL) measured by FACT-BMT score at day 100. Additional end points were collected: HRQOL by FACT-BMT score at baseline and at days 7, 14, 28, 60, and 100; transplantation-related mortality; length of hospital stay; intensive care unit admissions; acute graft-versus-host disease; Bearman toxicity score; sinusoidal obstruction syndrome; serious infections; WHO Bleeding Scale; transfusion requirements; and reactions to therapy. RESULTS A total of 300 patients were randomly assigned to either restrictive-strategy or liberal-strategy treatment groups between 2011 and 2016 at four Canadian adult HCT centers. After HCT, mean pre-transfusion Hb levels were 70.9 g/L in the restrictive-strategy group and 84.6 g/L in the liberal-strategy group ( P < .0001). The number of RBC units transfused was lower in the restrictive-strategy group than in the liberal-strategy group (mean, 2.73 units [standard deviation, 4.81 units] v 5.02 units [standard deviation, 6.13 units]; P = .0004). After adjusting for transfusion type and baseline FACT-BMT score, the restrictive-strategy group had a higher FACT-BMT score at day 100 (difference of 1.6 points; 95% CI, −2.5 to 5.6 points), which was noninferior compared with that of the liberal-strategy group. There were no significant differences in clinical outcomes between the transfusion strategies. CONCLUSION In patients undergoing HCT, the use of a restrictive RBC transfusion strategy threshold of 70 g/L was as effective as a threshold of 90 g/L and resulted in similar HRQOL and HCT outcomes with fewer transfusions.

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Section: Discussionmentioning

confidence: 99%

Liberal Versus Restrictive Red Blood Cell Transfusion Thresholds in Hematopoietic Cell Transplantation: A Randomized, Open Label, Phase III, Noninferiority Trial

Tay

Allan

Chatelain

et al. 2020

JCO

View full text Add to dashboard Cite

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“…Before full‐text review, we were informed of another article that met eligibility criteria that was not found on our original search strategy . After full‐text review, 7 articles and 16 abstracts were included (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

“…On the basis of the 16 abstracts included in the systematic review of evidence, there was insufficient information to produce a meta‐analysis (Appendix 5). The five studies that compared a single‐unit transfusion strategy with previous standard of care (which usually included multiple‐unit transfusions) demonstrated an absolute reduction in RBC transfusion by 10 to 31% . One prospective study also observed no differences in health‐related quality of life associated with changing from a multiple‐unit transfusion strategy to a single‐unit transfusion strategy .…”

Section: Resultsmentioning

confidence: 99%

Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies

et al. 2018

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BACKGROUND Recent recommendations indicate that one red blood cell (RBC) unit should be transfused at a time, with reassessment after each transfusion, which may be extrapolated from literature supporting restrictive transfusion triggers rather than specific evidence. Therefore, two systematic reviews were performed to identify the following: 1) RBC transfusion guidelines and review articles to determine if single‐ or multiple‐unit transfusion strategies are recommended and 2) studies comparing strategies for evidence of benefit. STUDY DESIGN AND METHODS MEDLINE, EMBASE, CINAHL, Web of Science, National Guideline Clearinghouse, and Trip Database were searched (inception to June 2017). For the first review, the proportion of articles with single/multiple‐unit recommendations was assessed and stratified by article type. For the second review, the primary outcome was RBC use. Secondary outcomes included proportion of transfusion episodes using a single‐unit strategy, length of stay, and mortality. RESULTS The first review identified 145 articles for analysis, with 51 transfusion guidelines. Only 14 guidelines (27%) made a recommendation, with most (93%) recommending single‐unit transfusions. The second review identified seven cohort studies comparing preimplementation and postimplementation of a policy encouraging single‐unit transfusion strategies. Meta‐analysis could not be performed for outcomes given inconsistencies in reporting. RBC use decreased by approximately 10 to 41% across studies. CONCLUSION Transfusion guidelines lack recommendations to transfuse to a single‐unit strategy. Mostly retrospective cohort studies (six of seven) are inconsistent in outcome reporting but suggest improved RBC use. Further high‐quality studies could identify the benefits of a single‐unit transfusion strategy, determine the applicability to different clinical settings, and inform future practice guidelines.

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Comparing the safety and efficacy of red blood cell transfusion dose in hematopoietic stem cell transplant patients: single versus double unit transfusions

Cited by 2 publications

References 0 publications

Liberal Versus Restrictive Red Blood Cell Transfusion Thresholds in Hematopoietic Cell Transplantation: A Randomized, Open Label, Phase III, Noninferiority Trial

Liberal Versus Restrictive Red Blood Cell Transfusion Thresholds in Hematopoietic Cell Transplantation: A Randomized, Open Label, Phase III, Noninferiority Trial

Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies

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