Impact of a Patient Blood Management Program and an Outpatient Anemia Management Protocol on Red Cell Transfusions in Oncology Inpatients and Outpatients

Gross, Irwin; Trentino, Kevin M.; Andreescu, Astrid C. M.; Pierson, Rhonda; Maietta, Richard A.; Farmer, Shannon

doi:10.1634/theoncologist.2015-0406

Cited by 23 publications

(10 citation statements)

References 19 publications

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“…The finding of no significant difference in mortality at lower haemoglobin levels in those not transfused may contribute to discussion surrounding tolerance of lower transfusion thresholds . The acceptance of lower haemoglobin levels in challenging patient populations adds to the feasibility of more restrictive haemoglobin thresholds being studied in RCTs, further avoiding exposure to red blood cells .…”

Section: Discussionmentioning

confidence: 99%

Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties: a retrospective cohort study

et al. 2019

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Few studies have investigated if, and how, red cell transfusion and anaemia interact. We analysed 60,955 admissions to three metropolitan hospitals in Western Australia between 2008 and 2017 to determine whether the relationship between red cell transfusion and outcomes in surgical patients differed by lowest (nadir) level of haemoglobin. At levels above 100 g.l À1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratios (ORs) (95%CI) being 8.80 (4.43-17.45) p < 0.001 and 3.68 (1.93-7.02) p < 0.001 and the adjusted hazard ratio (95%CI) being 1.83 (1.28-2.61) p = 0.001, respectively. Likewise, between 90 g.l À1 and 99 g.l À1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratio (95%CI) being 3.76 (2.23-6.34) p < 0.001 and 1.96 (1.23-3.12) p < 0.001 and the adjusted hazard ratio (95%CI) being 1.34 (1.05-1.70) p = 0.017, respectively. Length of stay was longer with transfusion at nadir haemoglobin levels above 100 g.l À1 and in the following ranges: 90-99 g.l À1 , 80-89 g.l À1 , 70-79 g.l À1 and 60-69 g.l À1 , the adjusted rate ratio (95%CI) being 1.38 (1.25-1.53) p < 0.001, 1.18 (1.10-1.27) p < 0.001, 1.17 (1.13-1.22) p < 0.001, 1.07 (1.02-1.12) p = 0.003 and 1.24 (1.13-1.36) p < 0.001, respectively. Mortality was higher with red cell transfusion at haemoglobin levels greater than 90 g.l À1 , whereas at all levels below 90 g.l À1 mortality was not significantly higher or lower. Length of stay was longer with transfusion at nadir haemoglobin levels of 60 g.l À1 or above. Our results suggest that nadir haemoglobin modified the relationship between red cell transfusion and outcomes and adds to the evidence recommending caution before transfusing red cells.

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Section: Discussionmentioning

confidence: 99%

Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties: a retrospective cohort study

et al. 2019

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“…Strategies to reduce RBC transfusion burden include single unit transfusion and a restrictive transfusion policy defined by use of a hemoglobin transfusion trigger of 7.0–8.0 g/dL . Gross et al observed a significant reduction of the mean number of RBC transfusions per patient after implementation of a patient blood management program in their cancer center (U.S.) despite marked decline in ESA use because of warnings issued by the Food and Drug Administration and regulatory restrictions . Excluding patients with leukemia, 198 patients received a mean of 5.3 RBC units during a 5‐year period from January 2008 to July 2013.…”

Section: Discussionmentioning

confidence: 99%

Lifetime Transfusion Burden and Transfusion-Related Iron Overload in Adult Survivors of Solid Malignancies

et al. 2019

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Background Limited data exist on transfusion burden and transfusion‐related iron overload in adult survivors of solid malignancies. Methods Hospital‐specific cancer registry data of patients with solid tumor receiving systemic anticancer treatment between January 2008 and September 2009 at the Oncology Department of the Leiden University Medical Center (The Netherlands) were retrieved and cross‐referenced with red blood cell (RBC) transfusion records. Individual lifetime transfusion burden was captured in April 2015. Multitransfused long‐term survivors with serum ferritin >500 μg/L were subsequently screened for hepatic and cardiac iron overload using 1.5 Tesla magnetic resonance imaging. Results The study population consisted of 775 adult patients with solid cancer (45.2% male; median age, 58 years; >75% chemotherapy‐treated), 423 (54.6%) of whom were transfused with a median of 6.0 RBC units (range 1–67). Transfusion triggers were symptomatic anemia or hemoglobin <8.1–8.9 g/dL prior to each myelosuppressive chemotherapy cycle. We identified 123 (15.9%) patients across all tumor types with a lifetime transfusion burden of ≥10 RBC units. In the absence of a hemovigilance program, none of these multitransfused patients was screened for iron overload despite a median survival of 4.6 years. In 2015 at disclosure of transfusion burden, 26 multitransfused patients were alive. Six (23.1%) had hepatic iron overload: 3.9–11.2 mg Fe/g dry weight. No cardiac iron depositions were found. Conclusion Patients with solid malignancies are at risk for multitransfusion and iron overload even when adhering to restrictive RBC transfusion policies. With improved long‐term cancer survivorship, increased awareness of iatrogenic side effects of supportive therapy and development of evidence‐based guidelines are essential. Implications for Practice In the presence of a restrictive transfusion policy, ∼30% of transfused adult patients with solid cancer are multitransfused and ∼50% become long‐term survivors, underscoring the need for evidence‐based guidelines for the detection and management of transfusion‐related iron overload in this group of patients. In each institution, a hemovigilance program should be implemented that captures the lifetime cumulative transfusion burden in all patients with cancer, irrespective of tumor type. This instrument will allow timely assessment and treatment of iron overload in cancer survivors, thus preventing organ dysfunction and decreased quality of life.

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“…Широкое внедрение МКП в практику здравоохранения имеет преимущества как на уровне пациента, так и на уровне общества в целом, поскольку оно улучшает ключевые показатели эффективности лечения пациентов, одновременно снижая потребление продуктов крови и затраты на него [34][35][36][37]. При эффективном МКП, как, например, внутривенном введении железа в пред-и постоперационных условиях или вне хирургической среды, пациентам, как правило, требуется меньше гемотрансфузий донорских компонентов крови [38,[136][137][138][139], что влечет сокращение риска осложнений, вызываемых переливанием крови.…”

Section: результаты лечения отмеченные при мкп и терапевтических схеunclassified

Patient blood management in oncology in the Russian Federation: resolution to improve oncology care.

et al. 2020

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The huge global burden of oncological diseases is growing and measures to counter this complex challenge are high on national health agendas. The Russian National Long-Term Oncology Strategy 2030 defines priorities, goals and directions in the fight against cancer. Italso contains action plans for more effective prevention, earlier and more specific diagnosis and more effective treatment options. Against this backdrop, experts now suggest to complement standard oncology treatment strategies by adding Patient Blood Management (PBM). For many clinical disciplines where a low blood count and considerable blood loss are commonly encountered, this bundle of care is the new standard. Based on clinical and scientific evidence, it aims to optimise medical and surgical patient outcomes by clinically managing and preserving a patients blood. The principles of this comprehensive concept can and must be transferred to oncology, thus offering value in improving cancer care and the efficacy of medical institutions. Accumulating evidence demonstrates that anaemia and iron deficiency, but also thrombocytopenia, blood loss and coagulopathy are independent risk factors for adverse patient outcomes including morbidity, mortality, reduced quality of life and prolonged average length of hospital stay in both surgical and medical patients. For the timely and effective detection and correction of these risk factors, an international network of multi-disciplinary clinicians and researchers has developed PBM. The rapidly growing body of evidence for PBM not only shows improved patient outcomes, but also reduced resource utilisation including the use of allogeneic blood components. The reduction of allogeneic blood transfusion further improves patient safety and outcomes, since transfusion is another independent risk factor for adverse outcomes. Supported by WHO endorsements and following the recommendations of an increasing number of state or national health authorities, PBM is about to become a new standard of care. However, even though the aforementioned risk factors are highly prevalent in oncology settings due to chemo-/radiotherapy and the pathology of the disease, the integration of PBM in standard oncology treatment pathways is lagging behind. Thus, and in support of the Russian National Long-Term Oncology Strategy 2030 to improve quality of oncological care, with the support of the National Association of Specialists in PBM (NASPBM), the PBM Oncology Working Group of the Russian Federation was created, consisting of national and international experts in oncology and PBM. On July 9, 2020, the Working Group met to discuss the rationale for PBM in oncology and to assess the need to implement PBM in Russian oncology care. As a result, the Group recommended to include PBM as an integral part of standard oncology treatment pathways, delineated the action required from facilitating stakeholders in the Russian Federation, determined a roadmap for implementation and developed a national resolution as a call to action on the matter. Presented herein, this resolution acknowledges the global and local impetus to reduce cancer mortality, and the rationale for PBM interventions to improve patient outcomes and alleviate the social and economic burden of cancer on the healthcare system.

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Impact of a Patient Blood Management Program and an Outpatient Anemia Management Protocol on Red Cell Transfusions in Oncology Inpatients and Outpatients

Cited by 23 publications

References 19 publications

Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties: a retrospective cohort study

Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties: a retrospective cohort study

Lifetime Transfusion Burden and Transfusion-Related Iron Overload in Adult Survivors of Solid Malignancies

Patient blood management in oncology in the Russian Federation: resolution to improve oncology care.

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