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 R 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

11 Citations (Scopus)

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)
JournalTransfusion
DOIs
StateAccepted/In press - 2016

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Blood Transfusion
Patient Care
Leukemia
Blood Platelets
Fibrinogen
Hemoglobins
Guidelines
Spinal Puncture
Thrombocytopenia
Inpatients
Outpatients
Erythrocytes
Bone Marrow
Clinical Trials
Biopsy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Pine, A. B., Lee, E. J., Sekeres, M., Steensma, D. P., Zelterman, D., Prebet, T., ... Zeidan, A. M. (Accepted/In press). Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States. Transfusion. https://doi.org/10.1111/trf.13934

Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States. / Pine, Alexander B.; Lee, Eun Ju; Sekeres, Mikkael; Steensma, David P.; Zelterman, Daniel; Prebet, Thomas; Dezern, Amy; Komrokji, Rami; Litzow, Mark R; Luger, Selina; Stone, Richard; Erba, Harry P.; Garcia-Manero, Guillermo; Lee, Alfred I.; Podoltsev, Nikolai A.; Barbarotta, Lisa; Kasberg, Stephanie; Hendrickson, Jeanne E.; Gore, Steven D.; Zeidan, Amer M.

In: Transfusion, 2016.

Research output: Contribution to journalArticle

Pine, AB, Lee, EJ, Sekeres, M, Steensma, DP, Zelterman, D, Prebet, T, Dezern, A, Komrokji, R, Litzow, MR, Luger, S, Stone, R, Erba, HP, Garcia-Manero, G, Lee, AI, Podoltsev, NA, Barbarotta, L, Kasberg, S, Hendrickson, JE, Gore, SD & Zeidan, AM 2016, 'Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States', Transfusion. https://doi.org/10.1111/trf.13934
Pine, Alexander B. ; Lee, Eun Ju ; Sekeres, Mikkael ; Steensma, David P. ; Zelterman, Daniel ; Prebet, Thomas ; Dezern, Amy ; Komrokji, Rami ; Litzow, Mark R ; Luger, Selina ; Stone, Richard ; Erba, Harry P. ; Garcia-Manero, Guillermo ; Lee, Alfred I. ; Podoltsev, Nikolai A. ; Barbarotta, Lisa ; Kasberg, Stephanie ; Hendrickson, Jeanne E. ; Gore, Steven D. ; Zeidan, Amer M. / Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States. In: Transfusion. 2016.
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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.",
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T1 - Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States

AU - Pine, Alexander B.

AU - Lee, Eun Ju

AU - Sekeres, Mikkael

AU - Steensma, David P.

AU - Zelterman, Daniel

AU - Prebet, Thomas

AU - Dezern, Amy

AU - Komrokji, Rami

AU - Litzow, Mark R

AU - Luger, Selina

AU - Stone, Richard

AU - Erba, Harry P.

AU - Garcia-Manero, Guillermo

AU - Lee, Alfred I.

AU - Podoltsev, Nikolai A.

AU - Barbarotta, Lisa

AU - Kasberg, Stephanie

AU - Hendrickson, Jeanne E.

AU - Gore, Steven D.

AU - Zeidan, Amer M.

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

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