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

Alexander B. Pine, Eun Ju Lee, Mikkael Sekeres, David P. Steensma, Daniel Zelterman, Thomas Prebet, Amy DeZern, Rami Komrokji, Mark Litzow, Selina Luger, Richard Stone, Harry P. Erba, Guillermo Garcia-Manero, Alfred I. Lee, Nikolai A. Podoltsev, Lisa Barbarotta, Stephanie Kasberg, Jeanne E. Hendrickson, Steven D. Gore, Amer M. Zeidan

Research output: Contribution to journalArticle

14 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)289-295
Number of pages7
JournalTransfusion
Volume57
Issue number2
DOIs
StatePublished - Feb 1 2017

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

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    Pine, A. B., Lee, E. J., Sekeres, M., Steensma, D. P., Zelterman, D., Prebet, T., DeZern, A., Komrokji, R., Litzow, M., Luger, S., Stone, R., Erba, H. P., Garcia-Manero, G., Lee, A. I., Podoltsev, N. A., Barbarotta, L., Kasberg, S., Hendrickson, J. E., Gore, S. D., & Zeidan, A. M. (2017). Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States. Transfusion, 57(2), 289-295. https://doi.org/10.1111/trf.13934