Efficacy of red blood cell transfusion relative to unit haemoglobin content in adult haematology-oncology patients.

BACKGROUND

The Haemoglobin (Hb) increment after a Red Blood Cell (RBC) transfusion is traditionally assumed to be one g/dL per unit in adult patients. However, actual increments vary, depending on the recipient characteristics and RBC unit quality. Our study aimed to assess the efficacy of single-unit RBC transfusion in adult hemato-oncological patients by evaluating post-transfusion Hb increments in relation to RBC unit haemoglobin content, and to identify recipient- and RBC unit-related factors influencing this response.

METHODS

The prospective observational study was conducted among adult hemato-oncology inpatients receiving RBC transfusions at a tertiary care centre in Central India. The pre- and post-transfusion haemoglobin levels were measured, and transfusion efficacy was calculated as Hb increment (ΔHb). RBC unit parameters of volume, haemoglobin content, and shelf life, and recipient factors of age, gender, diagnosis, total blood volume (TBV), and pre- and post-transfusion haemoglobin values, were recorded. Correlation and regression analyses were used to evaluate the association between Hb increment and influencing factors.

RESULTS

A total of 219 single-unit Red cell transfusions among 163 patients were analysed. The mean haemoglobin increment was 1.25 ± 0.79 g/dL. The haemoglobin increment positively correlated with the haemoglobin content of the RBC unit (r = 0.30, p < 0.001). Inverse correlation of haemoglobin increment was observed with the recipients' pre-transfusion haemoglobin concentration (r = -0.22, p = 0.001) and recipients' total blood volume (r = -0.21, p = 0.002). RBC units with higher haemoglobin content consistently yielded greater increments regardless of storage age. No significant differences were observed across age, gender, or diagnosis of these recipients. Linear regression suggested that for every 10 g increase in unit Hb content, the Hb increment increased by ~0.16 g/dL. Discrepancies between target and actual Hb increments were inversely correlated with unit Hb content (r = -0.749, p < 0.001).

CONCLUSION

The post-transfusion haemoglobin increment in adult haemato-oncology patients depends on recipient characteristics and the quality of the RBC unit. Standardising RBC preparation and labelling units with haemoglobin content can optimise transfusion efficiency, achieve target Hb levels with fewer units, and minimise donor exposure in chronically transfused patients.