Liberal versus restrictive transfusion in haemato-oncological patients undergoing autologous stem cell transplantation: A single-centre experience.

OBJECTIVES

Assess the safety and efficacy of restrictive transfusion in haemato-oncological patients undergoing autologous haematopoietic stem cell transplantation (AHSCT).

BACKGROUND

Restrictive transfusion is increasingly advocated within transfusion medicine to prevent over-treatment, lower transfusion-related adverse events and decrease healthcare costs. Yet there is a paucity of evidence regarding safe restrictive transfusion strategies in AHSCT patients.

METHODS

Double-unit transfusion at a haemoglobin threshold of 8 g/dL (i.e., liberal transfusion) is compared to single-unit transfusion at a haemoglobin threshold of 7 g/dL (i.e., restrictive transfusion) by means of an interrupted time series study. RBC utilisation, survival and the occurrence of complications were assessed for the initial hospitalisation period and at the hundredth day following AHSCT.

RESULTS

A group of 28 liberally transfused patients is compared to 18 restrictively transfused patients. Restrictively transfused patients received a median of 0.0 RBC units (IQR 0.0-1.0) and liberally transfused patients 2.0 RBC units (IQR 0.0-4.0) during hospitalisation (U = 127.5, p = 0.002). The number of RBC concentrates administered by day +100 remained significantly lower for restrictively (0.0 units, IQR 0.0-3.0) as opposed to liberally (2.0 units, IQR 0.0-4.0) transfused patients (U = 168.5, p = 0.026). Survival and readmission rates did not differ significantly between both groups. The most prevalent complications, regardless of the applied transfusion protocol, included mucositis, fever of unknown origin and various infections.

CONCLUSION

Restrictive transfusion through combined lowering of the haemoglobin trigger to 7 g/dL and single-unit transfusion effectively decreases RBC utilisation in a homogenous cohort of haemato-oncology patients undergoing AHSCT without hampering safety.