Blood use in patients receiving intensive chemotherapy for acute leukemia or hematopoietic stem cell transplantation: the impact of a health system–wide patient blood management program

Leahy, Michael F.; Trentino, Kevin M.; May, Colleen; Swain, Stuart G.; Chuah, Hun; Farmer, Shannon

doi:10.1111/trf.14191

Cited by 28 publications

(30 citation statements)

References 38 publications

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“…The results presented here represent the experience of a single academic medical center and may not be generalizable to other settings. However, other centers have reported similar results with PBM initiatives, suggesting the potential for broad applicability of these study findings …”

Section: Discussionsupporting

confidence: 73%

“…With increased recognition of the potential for patient harm and excessive health care costs associated with inappropriate transfusion practices, many institutions have attempted to reduce non–evidence‐based transfusion episodes. Formal, multidisciplinary programs for patient blood management (PBM), designed with the primary objective of optimizing patients' blood health, have also been associated with reduced blood product use. In many cases, these programs also reduce costs without detrimentally affecting important patient outcomes …”

mentioning

confidence: 99%

“…Indeed, patients undergoing intensive chemotherapy or hematopoietic stem cell transplantation (HSCT) often have profound anemia and thrombocytopenia, which are typically managed with allogeneic red blood cell (RBC) and platelet (PLT) transfusions, although transfusion practices may vary greatly among providers . Limited evidence has been published about the impact of PBM interventions on hematology patients or HSCT patients specifically, and further research in this clinical area is recommended by recently published PBM guidelines…”

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confidence: 99%

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Implementation of a patient blood management program in hematopoietic stem cell transplantation (Editorial, p. 2763)

et al. 2019

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BACKGROUND: Recipients of hematopoietic stem cell transplantation (HSCT) are among the highest consumers of allogeneic red blood cell (RBC) and platelet (PLT) components. The impact of patient blood management (PBM) efforts on HSCT recipients is poorly understood. STUDY DESIGN AND METHODS:This observational study assessed changes in blood product use and patient-centered outcomes before and after implementing a multidisciplinary PBM program for patients undergoing HSCT at a large academic medical center. The pre-PBM cohort was treated from January 1 through September 31, 2013; the post-PBM cohort was treated from January 1 through September 31, 2015. RESULTS:We identified 708 patients; 284 of 352 (80.7%) in the pre-PBM group and 225 of 356 (63.2%) in the post-PBM group received allogeneic RBCs (p < 0.001). Median (interquartile range [IQR]) RBC volumes were higher before PBM than after PBM (3 [2-4] units vs. 2 [1-4] units; p = 0.004). A total of 259 of 284 pre-PBM patients (91.2%) and 57 of 225 (25.3%) post-PBM patients received RBC transfusions when hemoglobin levels were more than 7 g/dL (p < 0.001). The median (IQR) PLT transfusion quantities was 3 (2-5) units for pre-PBM patients and 2 (1-4) units for post-PBM patients (p < 0.001). For patients with PLT counts of more than 10 × 10 9 /L, a total of 1219 PLT units (73.4%) were transfused before PBM and 691 units (48.8%) were transfused after PBM (p < 0.001). Estimated transfusion expenditures were reduced by $617,152 (18.3%). We noted no differences in clinical outcomes or transfusion-related adverse events. CONCLUSION: Patient blood management implementation for HSCT recipients was associated with marked reductions in allogeneic RBC and PLT transfusions and decreased transfusion-related costs with no detrimental impact on clinical outcomes.A llogeneic blood transfusion is the most common procedure performed in the United States, 1 but many transfusion episodes are inconsistent with evidence-based guidelines. With increased recognition of the potential for patient harm and excessive health care costs associated with inappropriate transfusion practices, many institutions have attempted to reduce non-evidencebased transfusion episodes. Formal, multidisciplinary programs for patient blood management (PBM), designed with the primary objective of optimizing patients' blood health, 2-11 have also been associated with reduced blood product use. In ABBREVIATIONS: HSCT = hematopoietic stem cell transplantation; ICU = intensive care unit; IQR = interquartile range; PBM = patient blood management.From the

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Section: Discussionsupporting

confidence: 73%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Implementation of a patient blood management program in hematopoietic stem cell transplantation (Editorial, p. 2763)

et al. 2019

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“…As mentioned above, PBM has shown efficacy in many clinical settings. However, there is a paucity of literature on PBM implementation for HSCT patients, and what is available mainly comes from one group in Australia . Seeing as HSCT patients are major users of blood products, development and implementation of PBM programs centered on these recipients are important and timely.…”

mentioning

confidence: 99%

The pillars of patient blood management: key to successful implementation (Article, p. 2840)

Sullivan

Roback

2019

Transfusion

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“…The 'per unit' risk estimates discussed in the above review should be considered together with the 'per patient' estimates, which take into account the highly variable numbers of allogeneic blood components required to treat different conditions. Well documented reviews of the latter have been published (Kleinman & Stassinopoulos, 2015;Leahy et al, 2017).…”

Section: Current Risk Of Transfusion Transmissible Infections In Haemmentioning

confidence: 99%

The long and winding road to pathogen reduction of platelets, red blood cells and whole blood

Rebulla

2019

Br J Haematol

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Summary Pathogen reduction technologies (PRTs) have been developed to further reduce the current very low risks of acquiring transfusion‐transmitted infections and promptly respond to emerging infectious threats. An entire portfolio of PRTs suitable for all blood components is not available, but the field is steadily progressing. While PRTs for plasma have been used for many years, PRTs for platelets, red blood cells (RBC) and whole blood (WB) were developed more slowly, due to difficulties in preserving cell functions during storage. Two commercial platelet PRTs use ultra violet (UV) A and UVB light in the presence of amotosalen or riboflavin to inactivate pathogens’ nucleic acids, while a third experimental PRT uses UVC light only. Two PRTs for WB and RBC have been tested in experimental clinical trials with storage limited to 21 or 35 days, due to unacceptably high RBC storage lesion beyond these time limits. This review summarizes pre‐clinical investigations and selected outcomes from clinical trials using the above PRTs. Further studies are warranted to decrease cell storage lesions after PRT treatment and to test PRTs in different medical and surgical conditions. Affordability remains a major administrative obstacle to PRT use, particularly so in geographical regions with higher risks of transfusion‐transmissible infections.

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Blood use in patients receiving intensive chemotherapy for acute leukemia or hematopoietic stem cell transplantation: the impact of a health system–wide patient blood management program

Abstract: The health system-wide PBM program had a significant impact, reducing blood product use and costs without increased morbidity or mortality in patients receiving intensive chemotherapy for acute leukemia or hematopoietic stem cell transplantation.

Cited by 28 publications

References 38 publications

Implementation of a patient blood management program in hematopoietic stem cell transplantation (Editorial, p. 2763)

Implementation of a patient blood management program in hematopoietic stem cell transplantation (Editorial, p. 2763)

The pillars of patient blood management: key to successful implementation (Article, p. 2840)

The long and winding road to pathogen reduction of platelets, red blood cells and whole blood

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