Objectives Although hemoglobin thresholds for red blood cell (RBC) transfusion have decreased, double‐unit RBC transfusion practices persist. We studied the effects switching from predominantly double‐unit to single‐unit RBC transfusions had on utilization and clinical outcomes for malignant hematology patients. Methods Retrospective chart review compared malignant hematology patients before and after implementing single‐unit RBC transfusion policy. Hemoglobin threshold was 8.0 g/dL for both groups. RBC utilization metrics included number of RBC units transfused, RBC units transfused per admission, and number of transfusion episodes. Clinical outcomes included length of stay, 30‐day mortality, and outpatient RBC transfusion 30‐days post‐discharge. Results Baseline hemoglobin was similar in both groups. The single‐unit group was transfused with fewer RBC units per admission (5.1 vs 4.5, P = 0.01) than the double‐unit group, but had more transfusion episodes per admission (4.1 vs 2.7, P < 0.001). After implementing single‐unit policy, a 29% reduction in RBC utilization was observed. Mean hemoglobin at discharge was lower in the single‐unit group (8.9 vs 9.5 g/dL, P = 0.005). No significant differences in length of stay or 30‐day mortality were observed. Conclusion Transfusing malignant hematology patients with single RBC units is safe and efficacious. Electronic provider order systems facilitating RBC transfusion requests provide excellent adherence to transfusion policy.

No abstract

Introduction Blood products are a valuable resource associated with infectious and immunological adverse effects, hence the ongoing efforts for blood conservation. Evidence supports the use of restrictive Hemoglobin (Hb) triggers as safe and effective. Nevertheless, transfusion practice remains based largely on physician preference. The use of single-unit (SU) rather than double-unit (DU) transfusions per transfusion episode may be another strategy. Scant retrospective data from the 1960's discarded this idea as being ineffective in treating anemia.A recent European study demonstrated that using a SU transfusion protocol led to a 25% reduction in red blood cell usage amongst patients with hematologic malignancies(Berger et al; Haematologica, 2012). There have been no comparative studies done in the US population outside the orthopedic population which yielded similar benefit (Ma et al; Transfusion Medicine, 2005). Clinical Decision Support Systems (CDSS) are protocols shown to be effective in standardizing practice. At our academic institution, a CDSS was initiated for admissions to the Malignant Hematology and Transplantation Service. From September 2014, a protocol amendment prompted providers to order SU red blood cells (RBCs) for transfusion for Hb <8. Herein, we report the adherence to CDSS, and the differences in RBC utilization and patient outcomes one year before (DU-gp) and one year after (SU-gp) implementation of this protocol. Methods Retrospective chart review was performed on all adult patients admitted to the Malignant Hematology and Transplantation Service who received routine RBC transfusions from 9/1/2013- 8/31/2014 (DU-gp) and 9/1/2014 to 8/31/2015 (SU-gp). Patients with active bleeding were excluded. The primary endpoint for this study was median RBC units transfused per admission. Analysis was limited to RBC products only. Chi-square test and t-test were used in the data analysis for categorical variables and continuous variables, respectively. A mixed model was used for repeated measurements. Results 147 patients in 201 admissions in DU-gp and 126 patients in 170 admissions in SU-gp were analyzed. Baseline characteristics are presented in Table 1 with no significant differences noted between groups. Excellent adherence to the CDSS protocol was noted in both the DU (97%) and SU (92%) groups. Baseline admission Hb was similar, but Hb at discharge was significantly higher in DU-gp 9.4 g/dL vs 8.8 g/dL in SU-gp (P=0.005). The median number of transfusion episodes (each time RBC orders were placed) per admission in the DU-gp and SU-gp was 2 (range, 1-16) and 3 (range, 1-27), respectively (P<0.001). The corresponding median number of RBC units given per admission was 4 (range, 1-29) and 3 (range, 1-44), respectively (P=0.02). Overall, a 29% reduction in RBC utilization was noted in SU-gp (731 units) compared to DU-gp (1031 units). No difference was noted in 30-day mortality and readmissions, outpatient transfusion requirements or transfusion reactions between the 2 groups (Table 2). Conclusions Our data show that implementing a CDSS, transfusing single-unit RBCs instead of double-units for Hb < 8g/dL had an excellent adherence, highlighting the feasibility of such a strategy. It is noteworthy that although patients required more transfusion encounters, the overall RBC utilization fell by 29%. Single-unit RBC transfusion was safe, efficacious and significantly reduced the RBC utilization per admission. Prospective data is required to confirm our results as well as assess the potential cost-benefit advantage with single-unit RBC transfusions. Disclosures No relevant conflicts of interest to declare.

Introduction:There is insufficient evidence regarding the optimal chemotherapy regimen for treatment of relapsed or refractory acute myeloid leukemia (RR-AML). We retrospectively compared the outcomes and toxicities between salvage chemotherapy with etoposide plus mitoxantrone (EM) versus clofarabine-based regimens in patients with RR-AML.

No abstract