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Transfusion. 2017 Feb;57(2):289-295. doi: 10.1111/trf.13934. Epub 2016 Nov 22.

Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States.

Author information

1
Yale New Haven Hospital, Cleveland, Ohio.
2
Department of Internal Medicine, Section of Hematology, Cleveland, Ohio.
3
Leukemia Program, Cleveland Clinic, Cleveland, Ohio.
4
Dana-Farber Cancer Institute, Boston, Massachusetts.
5
Yale University School of Public Health, New Haven, Connecticut.
6
The Johns Hopkins School of Medicine, Baltimore, Maryland.
7
Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida.
8
Mayo Clinic, Rochester, Minnesota.
9
Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
10
University of Alabama, Birmingham, Alabama.
11
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
12
Department of Laboratory Medicine, Yale University School of Medicine.

Abstract

BACKGROUND:

Transfusion of blood products is a key component of the supportive management in patients with acute leukemia (AL). However high-quality trial evidence and clinical outcome data to support specific transfusion goals for blood products for patients with AL remain limited leading to diverse transfusion practices. The primary objective of this study was to determine the spectrum of transfusion patterns in a variety of care settings among providers who treat AL patients.

STUDY DESIGN AND METHODS:

A 31-question survey queried providers caring for AL patients about the existence of institutional guidelines for transfusion of blood products, transfusion triggers for hemoglobin (Hb), platelets (PLTs), and fibrinogen in various settings including inpatient and outpatient and before procedures.

RESULTS:

We analyzed 130 responses and identified divergent transfusion Hb goals in hospitalized and ambulatory patients, fibrinogen goals for cryoprecipitate transfusions, and variation in practice for use of certain PLTs and red blood cell products. The least variable transfusion patterns were reported for PLT goals in thrombocytopenia and in the setting of invasive procedures such as bone marrow biopsy and lumbar punctures.

CONCLUSIONS:

This survey confirmed wide variations in blood product transfusion practices across several clinical scenarios in patients with AL. The findings emphasized the need for large prospective randomized trials to develop standardized evidence-based guidelines for blood product transfusions in patients with AL with the goal of limiting unnecessary transfusions without compromising outcomes.

PMID:
27878822
PMCID:
PMC5309168
DOI:
10.1111/trf.13934
[Indexed for MEDLINE]
Free PMC Article

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